Healthcare Provider Details

I. General information

NPI: 1760025738
Provider Name (Legal Business Name): JESSICA VICTORIA MILLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 11/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HIGH ST
BUFFALO NY
14203-1154
US

IV. Provider business mailing address

31 ALBERT CT
DEPEW NY
14043-1005
US

V. Phone/Fax

Practice location:
  • Phone: 716-859-5600
  • Fax:
Mailing address:
  • Phone: 716-951-9432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number024320
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number024320
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: