Healthcare Provider Details

I. General information

NPI: 1548641970
Provider Name (Legal Business Name): ELLIOTT YADON FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SENECA ST STE 646C
BUFFALO NY
14210-1351
US

IV. Provider business mailing address

1150 YOUNGS RD STE 104
WILLIAMSVILLE NY
14221-8096
US

V. Phone/Fax

Practice location:
  • Phone: 716-995-4450
  • Fax:
Mailing address:
  • Phone: 716-636-7979
  • Fax: 716-636-7993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95829
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF342959
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: