Provider Demographics
NPI:1487093936
Name:DILTZ, SHANTA N (RN)
Entity type:Individual
Prefix:
First Name:SHANTA
Middle Name:N
Last Name:DILTZ
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 1:401 PARKHURST BLVD
Mailing Address - Street 2:APT N
Mailing Address - City:BUFFALO
Mailing Address - State:NEW YORK
Mailing Address - Zip Code:14223
Mailing Address - Country:UM
Mailing Address - Phone:716-835-5240
Mailing Address - Fax:
Practice Address - Street 1:346 DELAWARE AVE
Practice Address - Street 2:WILLCARE
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-0000
Practice Address - Country:US
Practice Address - Phone:716-856-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY522456163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health