Healthcare Provider Details

I. General information

NPI: 1104754779
Provider Name (Legal Business Name): HUBA BROWN PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 ELMWOOD AVE APT 207
BUFFALO NY
14207-2470
US

IV. Provider business mailing address

1807 ELMWOOD AVE APT 207
BUFFALO NY
14207-2470
US

V. Phone/Fax

Practice location:
  • Phone: 646-270-1619
  • Fax:
Mailing address:
  • Phone: 646-270-1619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number407918
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: