Healthcare Provider Details

I. General information

NPI: 1164885067
Provider Name (Legal Business Name): DANIELLE CASILLO AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 08/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 E ROBINSON RD SUITE 207
WEST AMHERST NY
14228-2041
US

IV. Provider business mailing address

1150 YOUNGS RD SUITE 104
WILLIAMSVILLE NY
14221
US

V. Phone/Fax

Practice location:
  • Phone: 716-564-1111
  • Fax: 716-564-1128
Mailing address:
  • Phone: 716-636-7990
  • Fax: 716-636-7993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberF307626
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF307626-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: