Provider Demographics
NPI:1154404606
Name:SENECA NATION OF INDIANS
Entity type:Organization
Organization Name:SENECA NATION OF INDIANS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYBEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-532-5582
Mailing Address - Street 1:275 THOMAS INDIAN SCHOOL DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:NY
Mailing Address - Zip Code:14081-9341
Mailing Address - Country:US
Mailing Address - Phone:716-532-5582
Mailing Address - Fax:716-242-6344
Practice Address - Street 1:275 THOMAS INDIAN SCHOOL DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:NY
Practice Address - Zip Code:14081-9341
Practice Address - Country:US
Practice Address - Phone:716-532-5582
Practice Address - Fax:716-242-6344
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENECA NATION OF INDIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-20
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022975332800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03090966Medicaid
NY022975OtherNYS PHARMACY LICENSE
NY3301049OtherNABP