Provider Demographics
NPI:1477158103
Name:PUELLO PEREZ, LENNY LIDIA (FNP)
Entity type:Individual
Prefix:MRS
First Name:LENNY
Middle Name:LIDIA
Last Name:PUELLO PEREZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:LENNY
Other - Middle Name:LIDIA PUELLO
Other - Last Name:RAMOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:42 WOODBURY DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3533
Mailing Address - Country:US
Mailing Address - Phone:716-260-8360
Mailing Address - Fax:
Practice Address - Street 1:42 WOODBURY DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-3533
Practice Address - Country:US
Practice Address - Phone:716-260-8360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF341786-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily