Provider Demographics
NPI:1710366588
Name:SOTTILE-MALONA, BEVERLY (RN)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:SOTTILE-MALONA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8171 CLARENCE CENTER RD
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1948
Mailing Address - Country:US
Mailing Address - Phone:716-688-1537
Mailing Address - Fax:
Practice Address - Street 1:95 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-3925
Practice Address - Country:US
Practice Address - Phone:716-858-7010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233765163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator