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General NPI Number Information
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NPI Number | 1093264863
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Entity Type | Organization
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Legal Business Name | SHEILA NICHOLSON
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Dates
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Enumeration Date | 09/22/2016
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Last Update Date | 09/22/2016
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Provider Practice Location Address
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Address Line | 190 CARL ST
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City | BUFFALO
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State | NY
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Zip | 14215-3716
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Country | US
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Telephone | 304-400-3629
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Fax |
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Provider Business Mailing Address
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Address Line | 190 CARL ST
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City | BUFFALO
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State | NY
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Zip | 14215-3716
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LPN
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Name | MRS. SHEILA YVONNE NICHOLSON
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Credential | LPN
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Telephone | 304-400-3629
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 10326808
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License Number State | NY
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