Healthcare Provider Details

I. General information

NPI: 1154146348
Provider Name (Legal Business Name): PATRICIA PEARL FIDMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 MAIN ST FL 4
BUFFALO NY
14203-1009
US

IV. Provider business mailing address

1001 MAIN ST FL 4
BUFFALO NY
14203-1009
US

V. Phone/Fax

Practice location:
  • Phone: 716-550-8361
  • Fax:
Mailing address:
  • Phone: 716-550-8361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number354640
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: