Healthcare Provider Details

I. General information

NPI: 1699395210
Provider Name (Legal Business Name): LAUREN JAYNE GUGINO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4949 HARLEM RD
AMHERST NY
14226-2500
US

IV. Provider business mailing address

4225 GENESEE ST
CHEEKTOWAGA NY
14225-1994
US

V. Phone/Fax

Practice location:
  • Phone: 716-204-3200
  • Fax:
Mailing address:
  • Phone: 716-204-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMED-PAC-LIC-96642
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number026348
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMED-PAC-LIC-96642
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: