Healthcare Provider Details

I. General information

NPI: 1326095522
Provider Name (Legal Business Name): SHERRY ANN VEROSTKO-SLAZAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8207 MAIN ST STE 7-8
WILLIAMSVILLE NY
14221-6060
US

IV. Provider business mailing address

8207 MAIN ST STE 7-8
WILLIAMSVILLE NY
14221-6060
US

V. Phone/Fax

Practice location:
  • Phone: 716-277-0267
  • Fax: 716-803-8568
Mailing address:
  • Phone: 716-277-0267
  • Fax: 716-803-8568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number302553
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF3025531
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: