Healthcare Provider Details

I. General information

NPI: 1306898762
Provider Name (Legal Business Name): LORIANNE ELIZABETH AVINO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3671 SOUTHWESTERN BLVD SUITE 107
ORCHARD PARK NY
14127-1752
US

IV. Provider business mailing address

400 INTERNATIONAL DR
WILLIAMSVILLE NY
14221-5771
US

V. Phone/Fax

Practice location:
  • Phone: 716-667-2064
  • Fax: 716-667-2063
Mailing address:
  • Phone: 716-631-3555
  • Fax: 716-631-9525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number91475
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberDO201115
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2020032177
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number20791
License Number StateNH
# 5
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number237910-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: