Healthcare Provider Details

I. General information

NPI: 1932028859
Provider Name (Legal Business Name): MADELINE MINICUCCI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 MAPLE RD
WILLIAMSVILLE NY
14221-3647
US

IV. Provider business mailing address

4235 LOWER RIVER RD
YOUNGSTOWN NY
14174-9753
US

V. Phone/Fax

Practice location:
  • Phone: 716-568-3600
  • Fax:
Mailing address:
  • Phone: 716-799-2938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number357145
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: