Healthcare Provider Details

I. General information

NPI: 1861952582
Provider Name (Legal Business Name): STACY ANNE KNOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 11TH ST
NIAGARA FALLS NY
14301-1201
US

IV. Provider business mailing address

1001 11TH ST FL 3
NIAGARA FALLS NY
14301-1201
US

V. Phone/Fax

Practice location:
  • Phone: 716-278-8596
  • Fax:
Mailing address:
  • Phone: 716-278-8596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: