Healthcare Provider Details

I. General information

NPI: 1164496717
Provider Name (Legal Business Name): PAULA ZAGROBELNY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 OLEAN ST SUITE 220
EAST AURORA NY
14052-2540
US

IV. Provider business mailing address

112 OLEAN ST SUITE 220
EAST AURORA NY
14052-2540
US

V. Phone/Fax

Practice location:
  • Phone: 716-805-1072
  • Fax: 716-805-1073
Mailing address:
  • Phone: 716-805-1072
  • Fax: 716-805-1073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF332454
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: