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General NPI Number Information
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NPI Number | 1679823470
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Entity Type | Individual
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Provider Name | TENEIKA A GRAVELY FNP
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Gender | Female
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 139 CENTRE ST PH 120
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City | NEW YORK
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State | NY
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Zip | 10013-4559
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Country | US
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Telephone | 716-819-7701
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Fax |
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Provider Business Mailing Address
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Address Line | 438 GOODYEAR AVE
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City | BUFFALO
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State | NY
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Zip | 14211-2312
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Country | US
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Telephone | 716-819-7701
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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 | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | 650530-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 345689
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License Number State | NY
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