MEDICARE: DR. KRISTINA MYRA FOSTER SEMIDEY MD

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	207Q00000X	Family Medicine Physician	289970	NY

General Provider Information

NPI Number	:	1821484197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTINA MYRA FOSTER SEMIDEY MD

Provider Business Mailing Address
First Line	:	1150 YOUNGS RD STE 104
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-8096
Country	:	US
Telephone Number	:	716-636-7990
Fax Number	:	716-636-7993

Provider Business Practice Location Address
First Line	:	3950 E ROBINSON RD STE 207
Second Line	:
City	:	WEST AMHERST
State	:	NY
Zip	:	14228-2044
Country	:	US
Telephone Number	:	716-564-1111
Fax Number	:	716-564-1128

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

Provider Enumeration Date	:	04/13/2015
Last Update Date	:	12/03/2019

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