Healthcare Provider Details

I. General information

NPI: 1053409581
Provider Name (Legal Business Name): SENECA NATION OF INDIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

987 R C HOAG DR
SALAMANCA NY
14779-1365
US

IV. Provider business mailing address

987 R C HOAG DR
SALAMANCA NY
14779-1365
US

V. Phone/Fax

Practice location:
  • Phone: 716-945-5894
  • Fax: 716-242-6345
Mailing address:
  • Phone: 716-945-5894
  • Fax: 716-242-6345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberEXEMPT
License Number State

VIII. Authorized Official

Name: SHAELA MAYBEE
Title or Position: CEO
Credential:
Phone: 716-532-5582