Provider Demographics
NPI:1326299249
Name:MUSIAL, WANDA M (PNP/CDE)
Entity Type:Individual
Prefix:MS
First Name:WANDA
Middle Name:M
Last Name:MUSIAL
Suffix:
Gender:F
Credentials:PNP/CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 SWEET HOME RD.
Mailing Address - Street 2:SUITE 5
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-2777
Mailing Address - Country:US
Mailing Address - Phone:716-932-6064
Mailing Address - Fax:716-932-6076
Practice Address - Street 1:219 BRYANT ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-2006
Practice Address - Country:US
Practice Address - Phone:716-878-7588
Practice Address - Fax:716-888-3827
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY382004363LP0200X
NYF382004363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03090773Medicaid