Healthcare Provider Details

I. General information

NPI: 1336029412
Provider Name (Legal Business Name): TALLIA MANESS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6167 W QUAKER ST
ORCHARD PARK NY
14127-2640
US

IV. Provider business mailing address

6167 W QUAKER ST
ORCHARD PARK NY
14127-2640
US

V. Phone/Fax

Practice location:
  • Phone: 716-662-4800
  • Fax: 716-662-5700
Mailing address:
  • Phone:
  • Fax: 716-662-5700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: