Healthcare Provider Details

I. General information

NPI: 1326299249
Provider Name (Legal Business Name): WANDA M MUSIAL PNP/CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 BRYANT ST
BUFFALO NY
14222-2006
US

IV. Provider business mailing address

1400 SWEET HOME RD. SUITE 5
AMHERST NY
14228-2777
US

V. Phone/Fax

Practice location:
  • Phone: 716-878-7588
  • Fax: 716-888-3827
Mailing address:
  • Phone: 716-932-6064
  • Fax: 716-932-6076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number382004
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF382004
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: