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General NPI Number Information
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NPI Number | 1366261018
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Entity Type | Organization
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Legal Business Name | DAIJHA FULGHAM NURSE PRACTITIONER IN PSYCHIATRY PLLC
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Dates
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Enumeration Date | 10/09/2024
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 60 HEDLEY PL
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City | BUFFALO
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State | NY
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Zip | 14208-1061
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Country | US
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Telephone | 716-341-9644
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Fax |
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Provider Business Mailing Address
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Address Line | 32 CALDERWOOD DR
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City | BUFFALO
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State | NY
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Zip | 14215-1336
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Country | US
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Telephone | 716-341-9644
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Fax |
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Authorized Official
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Title or Position | PNP
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Name | MRS. DAIJHA CAPRICE FULGHAM
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Credential | NP
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Telephone | 716-341-9644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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