Healthcare Provider Details

I. General information

NPI: 1942093778
Provider Name (Legal Business Name): HEATHER JEAN INLUXAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2025
Last Update Date: 05/24/2025
Certification Date: 05/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4918 ROUTE 98
NORTH JAVA NY
14113-9754
US

IV. Provider business mailing address

4918 ROUTE 98
NORTH JAVA NY
14113-9754
US

V. Phone/Fax

Practice location:
  • Phone: 176-536-2850
  • Fax:
Mailing address:
  • Phone: 716-536-2850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number275559
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: