Provider Demographics
NPI:1528195617
Name:BENNETT, AMY M (CNP)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:M
Last Name:BENNETT
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:M
Other - Last Name:RUDNICKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:240 RED TAIL RD
Mailing Address - Street 2:STE 2
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1582
Mailing Address - Country:US
Mailing Address - Phone:716-649-6500
Mailing Address - Fax:716-649-0031
Practice Address - Street 1:4154 MCKINLEY PKY
Practice Address - Street 2:SUITE 1200
Practice Address - City:BLASDELL
Practice Address - State:NY
Practice Address - Zip Code:14219-2995
Practice Address - Country:US
Practice Address - Phone:716-649-6500
Practice Address - Fax:716-649-0031
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4205681363LW0102X
NY420568363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9512299OtherIHA
NY000560653001OtherBLUECROSS AND BLUESHIELD
NYCC9887Medicare ID - Type Unspecified
NY000560653001OtherBLUECROSS AND BLUESHIELD