Healthcare Provider Details

I. General information

NPI: 1811811060
Provider Name (Legal Business Name): SCARDINO INDEPENDENT SERVICE COORDINATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 PATRICIA DR
TONAWANDA NY
14150-4617
US

IV. Provider business mailing address

PO BOX 1320
BUFFALO NY
14226-7320
US

V. Phone/Fax

Practice location:
  • Phone: 716-863-9968
  • Fax: 716-409-4344
Mailing address:
  • Phone: 716-863-9968
  • Fax: 716-409-4344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: WARD SCARDINO GODZIK
Title or Position: PRESIDENT/CEO/SERVICE COORDINATOR
Credential:
Phone: 716-863-9968