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NPI Code Detail

MEDICARE: ELLEN E BRODY FNP

MEDICARE: ELLEN E BRODY FNP
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
1363LF0000XFamily Nurse PractitionerF343343NY

General Provider Information

NPI Number : 1568937779
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLEN E BRODY FNP
Provider Business Mailing Address
First Line : 1150 YOUNGS RD STE 104
Second Line :
City : WILLIAMSVILLE
State : NY
Zip : 14221-8096
Country : US
Telephone Number : 716-636-7979
Fax Number : 716-636-7993
Provider Business Practice Location Address
First Line : 1150 YOUNGS RD STE 104
Second Line :
City : WILLIAMSVILLE
State : NY
Zip : 14221-8096
Country : US
Telephone Number : 716-636-7979
Fax Number : 716-636-7993
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2018
Last Update Date : 10/04/2018

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Directions to “ ELLEN E BRODY FNP” Practice Location

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