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General NPI Number Information
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NPI Number | 1215250279
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Entity Type | Individual
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Provider Name | SHANNON D MARZULLO ANP
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Gender | Female
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Dates
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Enumeration Date | 03/04/2010
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Last Update Date | 02/11/2019
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Provider Practice Location Address
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Address Line | 50 LAKEFRONT BLVD SUITE 130
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City | BUFFALO
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State | NY
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Zip | 14202-4345
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Country | US
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Telephone | 716-849-8750
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Fax | 716-849-8757
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Provider Business Mailing Address
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Address Line | 3332 WALDEN AVE STE 110
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City | DEPEW
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State | NY
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Zip | 14043-2400
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Country | US
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Telephone | 716-849-8750
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Fax | 716-849-8757
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F305322-1
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License Number State | NY
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