Provider Demographics
NPI:1225689672
Name:GRAZIANO, LISA M (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:GRAZIANO
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 NORTHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1725
Mailing Address - Country:US
Mailing Address - Phone:716-639-8314
Mailing Address - Fax:
Practice Address - Street 1:1416 SWEET HOME RD STE 3
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2784
Practice Address - Country:US
Practice Address - Phone:716-574-9136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY402832363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health