Provider Demographics
NPI:1558404509
Name:REGALLA, SYLVIA HELEN (MD)
Entity Type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:HELEN
Last Name:REGALLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 INTERNATIONAL DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5771
Mailing Address - Country:US
Mailing Address - Phone:716-631-3555
Mailing Address - Fax:
Practice Address - Street 1:1425 DODGE RD
Practice Address - Street 2:
Practice Address - City:GETZVILLE
Practice Address - State:NY
Practice Address - Zip Code:14068-1311
Practice Address - Country:US
Practice Address - Phone:716-636-8423
Practice Address - Fax:716-636-9028
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133055207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00634524Medicaid
NYD01560Medicare UPIN
NY00634524Medicaid