Provider Demographics
NPI:1215287396
Name:GERMANA, RENAE D
Entity type:Individual
Prefix:
First Name:RENAE
Middle Name:D
Last Name:GERMANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RENAE
Other - Middle Name:
Other - Last Name:SMIEDALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5260 CHEW RD
Mailing Address - Street 2:
Mailing Address - City:SANBORN
Mailing Address - State:NY
Mailing Address - Zip Code:14132-9331
Mailing Address - Country:US
Mailing Address - Phone:541-951-4772
Mailing Address - Fax:
Practice Address - Street 1:3767 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1040
Practice Address - Country:US
Practice Address - Phone:716-874-6175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017052-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist