Provider Demographics
NPI:1174528301
Name:DHAFIR, COLLEEN M (NP)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:M
Last Name:DHAFIR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4085 SENECA ST
Mailing Address - Street 2:STE 3
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3000
Mailing Address - Country:US
Mailing Address - Phone:716-674-1180
Mailing Address - Fax:716-674-3027
Practice Address - Street 1:4085 SENECA ST
Practice Address - Street 2:STE 3
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3000
Practice Address - Country:US
Practice Address - Phone:716-674-1180
Practice Address - Fax:716-674-3027
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333650-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY50027761OtherMEDICARE TRAVELERS
NY9512281OtherINDEPENDENT HEALTH
NY00026511901OtherUNIVERA
NY000560713001OtherBLUE CROSS
NYDD2467Medicare PIN
NY00026511901OtherUNIVERA