Provider Demographics
NPI:1366252280
Name:GORE, ROYALTEE ROYANNAH (RN)
Entity type:Individual
Prefix:
First Name:ROYALTEE
Middle Name:ROYANNAH
Last Name:GORE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 CRESTWOOD PL
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14225-2615
Mailing Address - Country:US
Mailing Address - Phone:716-491-7378
Mailing Address - Fax:
Practice Address - Street 1:42 CRESTWOOD PL
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14225-2615
Practice Address - Country:US
Practice Address - Phone:716-491-7378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY895300163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse