Healthcare Provider Details

I. General information

NPI: 1902857790
Provider Name (Legal Business Name): DEBORAH MATTELIANO N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4855 CAMP RD STE 100
HAMBURG NY
14075-2600
US

IV. Provider business mailing address

571 TERRACE BLVD
DEPEW NY
14043-3610
US

V. Phone/Fax

Practice location:
  • Phone: 716-646-1084
  • Fax: 716-646-0763
Mailing address:
  • Phone: 716-683-4196
  • Fax: 716-646-0763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF3337891
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: