Provider Demographics
NPI:1831154939
Name:CELLINO, IVONNE S (MD)
Entity type:Individual
Prefix:DR
First Name:IVONNE
Middle Name:S
Last Name:CELLINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 ESSJAY RD STE 170
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8235
Mailing Address - Country:US
Mailing Address - Phone:716-630-1219
Mailing Address - Fax:716-817-1726
Practice Address - Street 1:3900 N BUFFALO ST
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1842
Practice Address - Country:US
Practice Address - Phone:716-656-4802
Practice Address - Fax:716-250-5930
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143256-1207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00808062Medicaid
NY000500185005OtherHEALTH NOW
NY00010027801OtherUNIVERA
NY161000580OtherNORTH AMERICAN PREFERRED
NY0703067OtherIHA
NY161000580OtherEMPIRE
NY0021748OtherGHI
NY060011490OtherRR MEDICARE
NY00808062Medicaid
NY000500185005OtherHEALTH NOW