Provider Demographics
NPI:1982399044
Name:BACOTE, DEMETRIA CELENA
Entity Type:Individual
Prefix:
First Name:DEMETRIA
Middle Name:CELENA
Last Name:BACOTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 SENECA ST APT 124
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14204-1967
Mailing Address - Country:US
Mailing Address - Phone:716-204-2412
Mailing Address - Fax:
Practice Address - Street 1:550 SENECA ST APT 124
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14204-1967
Practice Address - Country:US
Practice Address - Phone:716-204-2412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)