MEDICARE: MICHAELA SECKAROVA ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	003627-1	NY

General Provider Information

NPI Number	:	1205302064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAELA SECKAROVA ATC

Provider Business Mailing Address
First Line	:	295 MARYLAND ST APT 106
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14201-1975
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 WASHINGTON ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14203-3023
Country	:	US
Telephone Number	:	848-250-2426
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2018
Last Update Date	:	10/19/2018

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