Provider Demographics
NPI:1689034720
Name:SGROI, FAITH
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:SGROI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 YOUNGS RD STE 104
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8096
Mailing Address - Country:US
Mailing Address - Phone:716-636-7990
Mailing Address - Fax:716-636-7993
Practice Address - Street 1:3950 E ROBINSON RD STE 207
Practice Address - Street 2:
Practice Address - City:W AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2044
Practice Address - Country:US
Practice Address - Phone:716-564-1111
Practice Address - Fax:716-564-1128
Is Sole Proprietor?:No
Enumeration Date:2016-03-02
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307615363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04367048Medicaid