Provider Demographics
NPI:1851470207
Name:REEDY, ROBERTA LYNN (CRNA)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:LYNN
Last Name:REEDY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 KNOWLTON AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-2812
Mailing Address - Country:US
Mailing Address - Phone:716-871-1632
Mailing Address - Fax:
Practice Address - Street 1:VAWNYHCS 3495 BAILEY AVENUE
Practice Address - Street 2:ROUTING CODE 128
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215
Practice Address - Country:US
Practice Address - Phone:716-862-8727
Practice Address - Fax:716-862-6723
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY407390-1367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered