Healthcare Provider Details

I. General information

NPI: 1437578119
Provider Name (Legal Business Name): MARY KATHRYN MANNIX D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 E. ROBINSON RD STE. 205
WEST AMHERST NY
14228
US

IV. Provider business mailing address

8205 MAIN ST STE 10
WILLIAMSVILLE NY
14221-6054
US

V. Phone/Fax

Practice location:
  • Phone: 716-691-3400
  • Fax: 716-691-3404
Mailing address:
  • Phone: 716-539-0789
  • Fax: 716-250-9090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number288981
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: