Healthcare Provider Details

I. General information

NPI: 1023476223
Provider Name (Legal Business Name): MR. BRIAN SEAN BUNNY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3509 RANSOMVILLE RD
RANSOMVILLE NY
14131-9602
US

IV. Provider business mailing address

3509 RANSOMVILLE RD
RANSOMVILLE NY
14131-9602
US

V. Phone/Fax

Practice location:
  • Phone: 716-791-3571
  • Fax: 716-791-3398
Mailing address:
  • Phone: 716-791-3571
  • Fax: 716-791-3398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: