Healthcare Provider Details

I. General information

NPI: 1356583124
Provider Name (Legal Business Name): SEAN PATRICK BRADY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 YOUNGS RD
WILLIAMSVILLE NY
14221
US

IV. Provider business mailing address

1020 YOUNGS RD
WILLIAMSVILLE NY
14221-2698
US

V. Phone/Fax

Practice location:
  • Phone: 716-961-9900
  • Fax: 716-961-9911
Mailing address:
  • Phone: 716-961-9900
  • Fax: 716-961-9911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number265715
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: