Healthcare Provider Details

I. General information

NPI: 1700712270
Provider Name (Legal Business Name): ROOTS AND WINGS DEVELOPMENTAL STUDIO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 CORNELL DR
DEPEW NY
14043-1412
US

IV. Provider business mailing address

144 CORNELL DR
DEPEW NY
14043-1412
US

V. Phone/Fax

Practice location:
  • Phone: 716-341-6908
  • Fax:
Mailing address:
  • Phone: 716-341-6908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. LISA CANNA
Title or Position: DIRECTOR
Credential: MSED
Phone: 716-341-6908