Healthcare Provider Details

I. General information

NPI: 1225293780
Provider Name (Legal Business Name): MOLLY JANE CULLINAN M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 TIMBERLAKE DR
ORCHARD PARK NY
14127-3571
US

IV. Provider business mailing address

31 TIMBERLAKE DR
ORCHARD PARK NY
14127-3571
US

V. Phone/Fax

Practice location:
  • Phone: 716-860-0809
  • Fax:
Mailing address:
  • Phone: 716-860-0809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number013693-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: