Healthcare Provider Details

I. General information

NPI: 1720263767
Provider Name (Legal Business Name): GAYATRI SALWAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 GRIDER ST
BUFFALO NY
14215-3021
US

IV. Provider business mailing address

PO BOX 3392
BUFFALO NY
14240-3392
US

V. Phone/Fax

Practice location:
  • Phone: 716-961-6995
  • Fax: 716-362-9518
Mailing address:
  • Phone: 716-692-3302
  • Fax: 716-362-9518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number012091
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: