Healthcare Provider Details

I. General information

NPI: 1568959534
Provider Name (Legal Business Name): BRIAN MICHAEL SEDAR CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ELM AND CARLTON ST
BUFFALO NY
14263-0001
US

IV. Provider business mailing address

PO BOX 4806
QUEENSBURY NY
12804-0806
US

V. Phone/Fax

Practice location:
  • Phone: 716-845-2300
  • Fax: 716-845-8518
Mailing address:
  • Phone: 800-542-5759
  • Fax: 518-761-7037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number645819
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: