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General NPI Number Information
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NPI Number | 1275820441
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Entity Type | Individual
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Provider Name | VIVIEN LEAH REDEYE MD
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Gender | Female
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Dates
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Enumeration Date | 07/07/2011
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 3780 EAGLE ST
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City | FREDONIA
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State | NY
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Zip | 14063-9410
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Country | US
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Telephone | 716-672-3030
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Fax | 716-338-1567
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Provider Business Mailing Address
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Address Line | 103 ALLEN ST
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City | JAMESTOWN
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State | NY
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Zip | 14701-6968
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Country | US
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Telephone | 716-338-0022
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Fax |
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 88402
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 60276182
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 88402
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License Number State | SC
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