Provider Demographics
NPI:1285842500
Name:DEVERE, ELLEN DENISE (MD)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:DENISE
Last Name:DEVERE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3580 SHERIDAN DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1645
Mailing Address - Country:US
Mailing Address - Phone:716-835-7737
Mailing Address - Fax:716-835-3733
Practice Address - Street 1:3580 SHERIDAN DR
Practice Address - Street 2:SUITE 130
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1645
Practice Address - Country:US
Practice Address - Phone:716-835-7737
Practice Address - Fax:716-835-3733
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197364207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0298886OtherGHI - INDIVIDUAL
NY0710873OtherIHA - NO LONGER ACTIVE
NY00010044603OtherUNIVERA - NOT ACTIVE
NY01760278Medicaid
NY040426002348OtherFIDELIS
NY040426002348OtherFIDELIS
NYG12730Medicare UPIN