Individual
DR. MARIA ELENA MATALA-SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
4855 CAMP RD., SUITE 100, HAMBURG, NY 14075
(716) 646-1084
(716) 646-0786
Mailing address
4855 CAMP RD., SUITE 100, HAMBURG, NY 14075
(716) 646-1084
(716) 646-0786
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
210175
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01874813
—
NY
01
—
404544
WELLCARE
NY
Enumeration date
06/14/2006
Last updated
07/21/2014
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