Healthcare Provider Details

I. General information

NPI: 1578484002
Provider Name (Legal Business Name): LETRICE PEALS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4498 MAIN ST STE 4
BUFFALO NY
14226-3826
US

IV. Provider business mailing address

4498 MAIN ST STE 4
BUFFALO NY
14226-3826
US

V. Phone/Fax

Practice location:
  • Phone: 716-703-5600
  • Fax: 716-973-0231
Mailing address:
  • Phone: 716-703-5600
  • Fax: 716-973-1231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number433561
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: