Healthcare Provider Details

I. General information

NPI: 1760576763
Provider Name (Legal Business Name): COUNTY OF WAYNE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 NYE RD SUITE 200
LYONS NY
14489-9133
US

IV. Provider business mailing address

1519 NYE RD STE 200
LYONS NY
14489-9112
US

V. Phone/Fax

Practice location:
  • Phone: 315-946-5749
  • Fax: 315-946-5762
Mailing address:
  • Phone: 315-946-5749
  • Fax: 315-946-5762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number5823200R
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number5823200R
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number5823200R
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number5823200R
License Number StateNY

VIII. Authorized Official

Name: DIANE MARIE DEVLIN
Title or Position: DIRECTOR
Credential: RN, BSN
Phone: 315-946-5749