Provider Demographics
NPI:1720348261
Name:BELLI, BIANCA ANGELICA (DO)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:ANGELICA
Last Name:BELLI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 ARIELLE CT
Mailing Address - Street 2:APT D
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-1952
Mailing Address - Country:US
Mailing Address - Phone:847-372-2302
Mailing Address - Fax:
Practice Address - Street 1:5875 S. TRANSIT ROAD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094
Practice Address - Country:US
Practice Address - Phone:716-514-1166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390299999X207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine