Healthcare Provider Details

I. General information

NPI: 1346566817
Provider Name (Legal Business Name): STEPHANIE KOWALSKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3980 SHERIDAN DR STE 300
AMHERST NY
14226
US

IV. Provider business mailing address

3980 SHERIDAN DR STE 300
AMHERST NY
14226-1727
US

V. Phone/Fax

Practice location:
  • Phone: 716-250-2000
  • Fax: 716-250-2040
Mailing address:
  • Phone: 716-250-2000
  • Fax: 716-250-2040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA20870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: