Provider Demographics
NPI:1427345875
Name:DASTA, LISA MARLIN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARLIN
Last Name:DASTA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MICHELLE
Other - Last Name:MARLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203
Mailing Address - Country:US
Mailing Address - Phone:716-323-6050
Mailing Address - Fax:716-323-6672
Practice Address - Street 1:1001 MAIN ST.
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203
Practice Address - Country:US
Practice Address - Phone:716-323-6050
Practice Address - Fax:716-323-6672
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336846363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily