Healthcare Provider Details

I. General information

NPI: 1699915512
Provider Name (Legal Business Name): MELISSA DIANE HEFFLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 BEWLEY BUILDING
LOCKPORT NY
14094-2942
US

IV. Provider business mailing address

239 BEWLEY BUILDING
LOCKPORT NY
14094-2942
US

V. Phone/Fax

Practice location:
  • Phone: 716-439-1936
  • Fax: 716-439-1930
Mailing address:
  • Phone: 716-439-1936
  • Fax: 716-439-1930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number283650
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number283650
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: