Healthcare Provider Details

I. General information

NPI: 1346286614
Provider Name (Legal Business Name): NANCY ANN CIAVARRI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 BUFFALO ROAD SUITE 1
NORTH CHILI NY
14514-1256
US

IV. Provider business mailing address

PO BOX 505
NORTH CHILI NY
14514-0505
US

V. Phone/Fax

Practice location:
  • Phone: 585-594-5995
  • Fax: 585-594-5995
Mailing address:
  • Phone: 585-594-5995
  • Fax: 585-594-5424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number219913-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: