Provider Demographics
NPI:1245306729
Name:PYNE, CLIFFORD (ACNP)
Entity type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:
Last Name:PYNE
Suffix:
Gender:M
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 E FILLMORE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-1805
Mailing Address - Country:US
Mailing Address - Phone:716-870-1936
Mailing Address - Fax:
Practice Address - Street 1:401 N 8TH ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-2237
Practice Address - Country:US
Practice Address - Phone:716-373-3544
Practice Address - Fax:716-373-3546
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167152363LA2100X
NYF430215363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care