Individual
DEBORAH MATTELIANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
N.P
Contact information
Practice address
4855 CAMP RD, STE 100, HAMBURG, NY 14075-2600
(716) 646-1084
(716) 646-0763
Mailing address
571 TERRACE BLVD, DEPEW, NY 14043-3610
(716) 683-4196
(716) 646-0763
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F3337891
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00026523301
UNIVERA
—
01
—
000560744001
BLUE CROSS BLUE SHIELD
—
01
—
7599686
GHI
—
01
—
9512251
INDEPENDENT HEALTH
—
Enumeration date
05/15/2006
Last updated
09/26/2022
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