Healthcare Provider Details

I. General information

NPI: 1326034752
Provider Name (Legal Business Name): SHELLEY JAKEMAN WOJTASZCZYK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 BAILEY AVE
BUFFALO NY
14215-1145
US

IV. Provider business mailing address

7311 NORTHWOODS RD
ARCADE NY
14009-9530
US

V. Phone/Fax

Practice location:
  • Phone: 716-835-2966
  • Fax: 716-834-3901
Mailing address:
  • Phone: 585-496-2075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF331617-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: