Basic Information
| Provider Information | |||||||||
| NPI: | 1013478379 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPYRALATOS | ||||||||
| FirstName: | ZOE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1050 NIAGARA ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142132007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168840700 | ||||||||
| FaxNumber: | 7168840631 | ||||||||
| Practice Location | |||||||||
| Address1: | 1050 NIAGARA ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142132007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168840700 | ||||||||
| FaxNumber: | 7168840631 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2019 | ||||||||
| LastUpdateDate: | 12/20/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/20/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 673810 | NY | N | Nursing Service Providers | Registered Nurse | 363LP0808X | 402765 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.