Healthcare Provider Details

I. General information

NPI: 1740573559
Provider Name (Legal Business Name): ANDREA MICHELE COSTELLO SCHILLING DAOM,LA.C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. ANDREA M COSTELLO

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 WEHRLE DR STE 9
WILLIAMSVILLE NY
14221-7386
US

IV. Provider business mailing address

2821 WEHRLE DR STE 9
WILLIAMSVILLE NY
14221-7386
US

V. Phone/Fax

Practice location:
  • Phone: 716-984-5575
  • Fax: 716-633-0600
Mailing address:
  • Phone: 716-984-5575
  • Fax: 716-633-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25004571
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number008828-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: