Provider Demographics
NPI:1699874354
Name:DAIGLER, DOROTHY (PNP)
Entity type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:
Last Name:DAIGLER
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:MISS
Other - First Name:DOROTHY
Other - Middle Name:
Other - Last Name:WOODS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4511 HARLEM RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3803
Mailing Address - Country:US
Mailing Address - Phone:716-839-6720
Mailing Address - Fax:716-839-6740
Practice Address - Street 1:219 BRYANT ST
Practice Address - Street 2:GENERAL PEDIATRIC DIVISION
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-2006
Practice Address - Country:US
Practice Address - Phone:716-878-7288
Practice Address - Fax:716-888-3966
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176460163WP0200X
NYF380688363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY080407000148OtherFIDELIS
NY02105448Medicaid
P28417Medicare UPIN
NY02105448Medicaid