MEDICARE: MADELYN HENRY

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	40401768	NY

General Provider Information

NPI Number	:	1538535695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELYN HENRY

Provider Business Mailing Address
First Line	:	255 DELAWARE AVE
Second Line	:	SUITE 300
City	:	BUFFALO
State	:	NY
Zip	:	14202-2016
Country	:	US
Telephone Number	:	716-842-0440
Fax Number	:	716-842-4069

Provider Business Practice Location Address
First Line	:	255 DELAWARE AVE
Second Line	:	SUITE 300
City	:	BUFFALO
State	:	NY
Zip	:	14202-2016
Country	:	US
Telephone Number	:	716-842-0440
Fax Number	:	716-842-4069

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

Provider Enumeration Date	:	08/12/2015
Last Update Date	:	08/12/2015

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