Healthcare Provider Details

I. General information

NPI: 1871547463
Provider Name (Legal Business Name): AMY LYNN WNEK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3675 SOUTHWESTERN BLVD
ORCHARD PARK NY
14127-1732
US

IV. Provider business mailing address

3675 SOUTHWESTERN BLVD
ORCHARD PARK NY
14127-1732
US

V. Phone/Fax

Practice location:
  • Phone: 716-972-0279
  • Fax:
Mailing address:
  • Phone: 716-972-0279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number225912-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number225912-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: