Healthcare Provider Details

I. General information

NPI: 1508467481
Provider Name (Legal Business Name): CHRISTOPHER TODD NUTTY NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 AMSDELL RD
HAMBURG NY
14075-5835
US

IV. Provider business mailing address

1099 COLVIN BLVD
BUFFALO NY
14223-1904
US

V. Phone/Fax

Practice location:
  • Phone: 716-649-9000
  • Fax:
Mailing address:
  • Phone: 716-310-8781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberF346879-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: