Provider Demographics
NPI:1548663628
Name:BURKE, MUFIYDA (LPN)
Entity type:Individual
Prefix:MISS
First Name:MUFIYDA
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 DONOVAN DR APT C
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14211-1448
Mailing Address - Country:US
Mailing Address - Phone:716-598-6551
Mailing Address - Fax:716-881-7595
Practice Address - Street 1:245 BASSETT RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2638
Practice Address - Country:US
Practice Address - Phone:716-207-4041
Practice Address - Fax:716-881-7595
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317555-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse