Provider Demographics
NPI:1902306491
Name:SEITAJ, NICOLE AMANDA (AGPCNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:AMANDA
Last Name:SEITAJ
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6255 SHERIDAN DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8096
Mailing Address - Country:US
Mailing Address - Phone:716-564-1111
Mailing Address - Fax:716-929-0194
Practice Address - Street 1:3950 E ROBINSON RD STE 207
Practice Address - Street 2:
Practice Address - City:WEST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2044
Practice Address - Country:US
Practice Address - Phone:716-564-1111
Practice Address - Fax:716-929-0194
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF308586363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health