Provider Demographics
NPI:1699753053
Name:WHEATFIELD PEDIATRICS, LLP
Entity type:Organization
Organization Name:WHEATFIELD PEDIATRICS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:B
Authorized Official - Last Name:DEVANTIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-807-7337
Mailing Address - Street 1:2890 NIAGARA FALLS BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-1114
Mailing Address - Country:US
Mailing Address - Phone:716-807-7337
Mailing Address - Fax:716-807-0848
Practice Address - Street 1:2890 NIAGARA FALLS BLVD
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-1114
Practice Address - Country:US
Practice Address - Phone:716-807-7337
Practice Address - Fax:716-807-0848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02070184Medicaid