Healthcare Provider Details

I. General information

NPI: 1922323005
Provider Name (Legal Business Name): MR. PAUL GUGLIELMO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 04/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10714 NORTH RD
PERRYSBURG NY
14129-9746
US

IV. Provider business mailing address

108 CAREFREE LN
CHEEKTOWAGA NY
14227-2219
US

V. Phone/Fax

Practice location:
  • Phone: 716-532-1049
  • Fax: 716-532-0679
Mailing address:
  • Phone: 716-668-5380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000059-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: