Provider Demographics
NPI:1275806812
Name:SHIRLEY A. CONRAD INC
Entity Type:Organization
Organization Name:SHIRLEY A. CONRAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CONRAD
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:716-866-2826
Mailing Address - Street 1:20 RAMONA AVENUE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14220-2307
Mailing Address - Country:US
Mailing Address - Phone:716-866-2826
Mailing Address - Fax:716-825-1994
Practice Address - Street 1:4211 NORTH BUFFALO STREET
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127
Practice Address - Country:US
Practice Address - Phone:716-866-2826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014646-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty