=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245129105
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NURSE PRACTITIONER IN PSYCHIATRY OF WNY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2025
-----------------------------------------------------
Last Update Date | 09/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3911 N BUFFALO ST
-----------------------------------------------------
City | ORCHARD PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14127-1841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-603-6680
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3911 N BUFFALO ST
-----------------------------------------------------
City | ORCHARD PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14127-1841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JULIE FITT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 716-603-6680
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------