Healthcare Provider Details

I. General information

NPI: 1033113931
Provider Name (Legal Business Name): PEI SAN HUANG CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3095 HARLEM RD
CHEEKTOWAGA NY
14225-2500
US

IV. Provider business mailing address

4511 HARLEM RD RM 3
AMHERST NY
14226-3822
US

V. Phone/Fax

Practice location:
  • Phone: 716-896-3815
  • Fax: 716-896-3015
Mailing address:
  • Phone: 716-886-0444
  • Fax: 716-885-7070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number524499
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: