Provider Demographics
NPI:1932788833
Name:CHELLINO, TRACY LYNN (ANP)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LYNN
Last Name:CHELLINO
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 WEHRLE DR STE 13
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7385
Mailing Address - Country:US
Mailing Address - Phone:716-458-0005
Mailing Address - Fax:716-989-5030
Practice Address - Street 1:2809 WEHRLE DR STE 13
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7385
Practice Address - Country:US
Practice Address - Phone:716-458-0005
Practice Address - Fax:716-989-5030
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310216207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine