Healthcare Provider Details

I. General information

NPI: 1306333737
Provider Name (Legal Business Name): NURSE PRACTITIONER OF ERIE NIAGARA PSYCHIATRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 04/20/2018
Certification Date:
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: 716-677-4240
Mailing address:
  • Phone: 716-908-5433
  • Fax: 716-677-4240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number401043
License Number StateNY

VIII. Authorized Official

Name: STEFANIA FYNN-AIKINS
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 716-908-5433