Basic Information
| Provider Information | |||||||||
| NPI: | 1518611599 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHOUDHURY | ||||||||
| FirstName: | SIDDIKA | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 206 S ELMWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142012398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168472441 | ||||||||
| FaxNumber: | 7168472715 | ||||||||
| Practice Location | |||||||||
| Address1: | 1206 WALDEN AVE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142112830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9293317113 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2022 | ||||||||
| LastUpdateDate: | 02/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 795449 | NY | Y | Nursing Service Providers | Registered Nurse |
No ID Information.