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NPI Code Detail

MEDICARE: DEBORAH MATTELIANO N.P

MEDICARE: DEBORAH MATTELIANO N.P
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 PractitionerF3337891NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100026523301OTHERUNIVERA
27599686OTHERGHI
39512251OTHERINDEPENDENT HEALTH
4000560744001OTHERBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1902857790
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH MATTELIANO N.P
Provider Business Mailing Address
First Line : 571 TERRACE BLVD
Second Line :
City : DEPEW
State : NY
Zip : 14043-3610
Country : US
Telephone Number : 716-683-4196
Fax Number : 716-646-0763
Provider Business Practice Location Address
First Line : 4855 CAMP RD
Second Line : STE 100
City : HAMBURG
State : NY
Zip : 14075-2600
Country : US
Telephone Number : 716-646-1084
Fax Number : 716-646-0763
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2006
Last Update Date : 09/26/2022

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