Individual
TEALE LYNN DIDOMENICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3176 ABBOTT RD, ORCHARD PARK, NY 14127-1069
(716) 822-2117
Mailing address
3176 ABBOTT RD, ORCHARD PARK, NY 14127-1069
(716) 822-2117
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
409218754
NY
Other
Enumeration date
07/19/2024
Last updated
07/24/2024
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