Healthcare Provider Details

I. General information

NPI: 1740544030
Provider Name (Legal Business Name): KEVIN J CUDDAHEE FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HIGH ST
BUFFALO NY
14203-1126
US

IV. Provider business mailing address

40 GEORGE KARL BLVD
WILLIAMSVILLE NY
14221-7183
US

V. Phone/Fax

Practice location:
  • Phone: 716-859-5600
  • Fax:
Mailing address:
  • Phone: 716-218-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number337357
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: