Healthcare Provider Details

I. General information

NPI: 1659283943
Provider Name (Legal Business Name): SHIRLEY ANN LANDS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BROAD ST
TONAWANDA NY
14150-1910
US

IV. Provider business mailing address

400 BROAD ST
TONAWANDA NY
14150-1910
US

V. Phone/Fax

Practice location:
  • Phone: 716-243-6185
  • Fax:
Mailing address:
  • Phone: 716-243-6185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number335117
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: