Healthcare Provider Details

I. General information

NPI: 1962155325
Provider Name (Legal Business Name): DARIA ZOFIA SIMON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DARIA ZOFIA GORZUCH

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 ELLICOTT ST
BUFFALO NY
14203-1021
US

IV. Provider business mailing address

81 CROFTON DR
WEST SENECA NY
14224-4426
US

V. Phone/Fax

Practice location:
  • Phone: 716-323-2000
  • Fax:
Mailing address:
  • Phone: 716-572-7046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF345888-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: