1417441262 NPI number — SHERRY ANN VEROSTKO-SLAZAK DBA COMPASSIONATE HEALTHCARE

Table of content: (NPI 1417441262)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417441262 NPI number — SHERRY ANN VEROSTKO-SLAZAK DBA COMPASSIONATE HEALTHCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHERRY ANN VEROSTKO-SLAZAK DBA COMPASSIONATE HEALTHCARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417441262
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1967 WEHRLE DR STE 10
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14221-8452
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-458-0752
Provider Business Mailing Address Fax Number:
716-803-8568

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1967 WEHRLE DR STE 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14221-8452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-458-0752
Provider Business Practice Location Address Fax Number:
716-803-8568
Provider Enumeration Date:
06/15/2018

Additional Information

Authorized Official

Authorized Official Last Name:
VEROSTKO-SLAZAK
Authorized Official First Name:
SHERRY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
ANP
Authorized Official Telephone Number:
716-458-0752

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  302553 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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