Healthcare Provider Details

I. General information

NPI: 1285386276
Provider Name (Legal Business Name): STEPHANIE MARGARET SMALL ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE MARGARET HASPETT

II. Dates (important events)

Enumeration Date: 01/21/2022
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 RED TAIL RD STE 9
ORCHARD PARK NY
14127-1599
US

IV. Provider business mailing address

1524 SWEET RD
EAST AURORA NY
14052-3043
US

V. Phone/Fax

Practice location:
  • Phone: 716-503-1740
  • Fax:
Mailing address:
  • Phone: 716-704-5915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number310692
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: