Provider Demographics
NPI:1982850350
Name:FELLER, MARIA LISA (MSED)
Entity Type:Individual
Prefix:MR
First Name:MARIA
Middle Name:LISA
Last Name:FELLER
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5121 CLEARVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4107
Mailing Address - Country:US
Mailing Address - Phone:716-400-4501
Mailing Address - Fax:
Practice Address - Street 1:5121 CLEARVIEW DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-4107
Practice Address - Country:US
Practice Address - Phone:716-400-4501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-17
Last Update Date:2008-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor