Provider Demographics
NPI:1952499204
Name:NYLANDER, EMMEKUNLA K (MD)
Entity Type:Individual
Prefix:
First Name:EMMEKUNLA
Middle Name:K
Last Name:NYLANDER
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 1:4575 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4567
Mailing Address - Country:US
Mailing Address - Phone:716-633-4575
Mailing Address - Fax:716-633-4576
Practice Address - Street 1:4575 MAIN ST
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-4567
Practice Address - Country:US
Practice Address - Phone:716-633-4575
Practice Address - Fax:716-633-4576
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224648-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00026065005OtherUNIVERA
NY00052683005OtherBC/BS
NY456683OtherWELLCARE
NY00526830006OtherBC/BS
NY040930000024OtherFIDELIS
NY02298800Medicaid
NY87319OtherGHI HMO
NY0296781OtherGHI PPO
NY150507-CKOtherPREFERRED CARE
NY0711449OtherINDEPENDENT HEALTH
NYH68571Medicare UPIN
NY040930000024OtherFIDELIS
NYRB2118Medicare PIN