Healthcare Provider Details

I. General information

NPI: 1609983584
Provider Name (Legal Business Name): KARA LYNN MCCUNN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 WALDEN AVENUE SUITE 400
CHEEKTOWAGA NY
14225-4985
US

IV. Provider business mailing address

400 FOREST AVENUE
BUFFALO NY
14304
US

V. Phone/Fax

Practice location:
  • Phone: 716-895-6700
  • Fax: 716-332-4488
Mailing address:
  • Phone: 716-816-2285
  • Fax: 716-332-4488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number043598
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number234306
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: