Provider Demographics
NPI:1265793046
Name:REYNOLDS, DEVONYA (RN BSN)
Entity type:Individual
Prefix:
First Name:DEVONYA
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 FAIRGREEN DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-1863
Mailing Address - Country:US
Mailing Address - Phone:716-248-9146
Mailing Address - Fax:
Practice Address - Street 1:150 ZENNER ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14211-1731
Practice Address - Country:US
Practice Address - Phone:716-248-9146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY553079163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse