Provider Demographics
NPI:1417202953
Name:WNEK BANDURA, KIMBERLY MARIE (COMS)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MARIE
Last Name:WNEK BANDURA
Suffix:
Gender:F
Credentials:COMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 WOODMAR TER
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-4137
Mailing Address - Country:US
Mailing Address - Phone:716-984-1855
Mailing Address - Fax:
Practice Address - Street 1:700 SWEET HOME RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1444
Practice Address - Country:US
Practice Address - Phone:716-836-7556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY38442255R0406X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, Blind
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3844OtherCOMS CERTIFICATION