Basic Information
| Provider Information | |||||||||
| NPI: | 1508124892 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAVERS | ||||||||
| FirstName: | TIFFANY | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 CLEVELAND DR | ||||||||
| Address2: | |||||||||
| City: | CHEEKTOWAGA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142151807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166021282 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 244 HEMPSTEAD AVE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142153404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168317877 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2012 | ||||||||
| LastUpdateDate: | 07/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 696362 | NY | Y | Nursing Service Providers | Registered Nurse |
No ID Information.