Healthcare Provider Details

I. General information

NPI: 1639032618
Provider Name (Legal Business Name): TIFFANY DENAULT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2495 ELMWOOD AVE
KENMORE NY
14217-2222
US

IV. Provider business mailing address

140 CONDON AVE
BUFFALO NY
14207-1144
US

V. Phone/Fax

Practice location:
  • Phone: 716-882-2127
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: