Healthcare Provider Details

I. General information

NPI: 1275820441
Provider Name (Legal Business Name): VIVIEN LEAH REDEYE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 09/17/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3780 EAGLE ST
FREDONIA NY
14063-9410
US

IV. Provider business mailing address

103 ALLEN ST
JAMESTOWN NY
14701-6968
US

V. Phone/Fax

Practice location:
  • Phone: 716-672-3030
  • Fax: 716-338-1567
Mailing address:
  • Phone: 716-338-0022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number88402
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number60276182
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number88402
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: