Provider Demographics
NPI:1497787618
Name:KENNEY, LISA S (DO)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:S
Last Name:KENNEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 ALBERTA DR
Mailing Address - Street 2:STE 107
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226
Mailing Address - Country:US
Mailing Address - Phone:716-446-5506
Mailing Address - Fax:716-445-5509
Practice Address - Street 1:350 ALBERTA DR
Practice Address - Street 2:STE 107
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226
Practice Address - Country:US
Practice Address - Phone:716-446-5506
Practice Address - Fax:716-445-5509
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1853591207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F41673Medicare UPIN
CC2021Medicare ID - Type Unspecified