Healthcare Provider Details

I. General information

NPI: 1780047241
Provider Name (Legal Business Name): BRANDON MICHAEL FYOCK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 AMSDELL RD
HAMBURG NY
14075-5835
US

IV. Provider business mailing address

3040 AMSDELL RD
HAMBURG NY
14075-5835
US

V. Phone/Fax

Practice location:
  • Phone: 716-646-6700
  • Fax: 716-646-8515
Mailing address:
  • Phone: 716-646-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number298655
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: