MEDICARE: MRS. AUDREY DOREEN SMITH RPA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	078191	NY

General Provider Information

NPI Number	:	1306840285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AUDREY DOREEN SMITH RPA-C

Provider Business Mailing Address
First Line	:	30 N UNION RD
Second Line	:	STE 104
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-5367
Country	:	US
Telephone Number	:	716-565-3990
Fax Number	:	716-565-3988

Provider Business Practice Location Address
First Line	:	30 N UNION RD
Second Line	:	STE 104
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-5367
Country	:	US
Telephone Number	:	716-565-3990
Fax Number	:	716-565-3988

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	02/19/2008

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