Provider Demographics
NPI:1033117809
Name:EHLENFIELD, DARYL ROY (MD)
Entity Type:Individual
Prefix:
First Name:DARYL
Middle Name:ROY
Last Name:EHLENFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-1110
Mailing Address - Country:US
Mailing Address - Phone:716-332-4472
Mailing Address - Fax:716-332-4474
Practice Address - Street 1:560 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1110
Practice Address - Country:US
Practice Address - Phone:716-332-4472
Practice Address - Fax:716-332-4474
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209031208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY144080DLOtherPREFERRED CARE
NY01856573Medicaid
NY000525174009OtherCOMMUNITY BLUE
NY1201351OtherIHA
NY00010364108OtherUNIVERA
NY040426001840OtherFIDELIS
NY144080DLOtherPREFERRED CARE
NY000525174009OtherCOMMUNITY BLUE