Healthcare Provider Details

I. General information

NPI: 1174468581
Provider Name (Legal Business Name): CARLETTA AMMOR YOUNGSAM-COLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HIGH ST
BUFFALO NY
14203-1126
US

IV. Provider business mailing address

1120 LA SALLE AVE
NIAGARA FALLS NY
14301-1250
US

V. Phone/Fax

Practice location:
  • Phone: 647-867-7444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF357776-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: