Provider Demographics
NPI:1548277643
Name:ANNALETT, DIANE SMITH (MD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:SMITH
Last Name:ANNALETT
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 501
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14231-0501
Mailing Address - Country:US
Mailing Address - Phone:716-831-9030
Mailing Address - Fax:716-831-9075
Practice Address - Street 1:479 ENGLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14223-2862
Practice Address - Country:US
Practice Address - Phone:716-831-9030
Practice Address - Fax:716-831-9075
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2084P0805X2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF05510Medicare UPIN