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General NPI Number Information
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NPI Number | 1427345875
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Entity Type | Individual
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Provider Name | LISA MARLIN DASTA FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/06/2011
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Last Update Date | 02/02/2023
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Provider Practice Location Address
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Address Line | 1001 MAIN ST.
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City | BUFFALO
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State | NY
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Zip | 14203
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Country | US
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Telephone | 716-323-6050
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Fax | 716-323-6672
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Provider Business Mailing Address
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Address Line | 1001 MAIN ST.
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City | BUFFALO
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State | NY
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Zip | 14203
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Country | US
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Telephone | 716-323-6050
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Fax | 716-323-6672
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 336846
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License Number State | NY
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