Healthcare Provider Details

I. General information

NPI: 1770522799
Provider Name (Legal Business Name): KALEIDA HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3251 S CREEK RD
HAMBURG NY
14075-6167
US

IV. Provider business mailing address

3251 S CREEK RD
HAMBURG NY
14075-6167
US

V. Phone/Fax

Practice location:
  • Phone: 716-649-7939
  • Fax:
Mailing address:
  • Phone: 716-649-7939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number300545
License Number StateNY

VIII. Authorized Official

Name: MRS. NANCY R. WALSH
Title or Position: NEONATAL NURSE PRACTITIONER
Credential: NNP
Phone: 716-878-7481