Healthcare Provider Details

I. General information

NPI: 1578385324
Provider Name (Legal Business Name): NURSE PRACTITIONER OF ERIE NIAGARA PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 SENECA ST
WEST SENECA NY
14224-3433
US

IV. Provider business mailing address

3802 SENECA ST
WEST SENECA NY
14224-3433
US

V. Phone/Fax

Practice location:
  • Phone: 716-677-5418
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ABA FYNN-AIKINS
Title or Position: PSYCHIATRIC NURSE PRACTITIONER
Credential:
Phone: 716-906-7610