Healthcare Provider Details

I. General information

NPI: 1902306442
Provider Name (Legal Business Name): LAURA CHRISTINA PARADISI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 HIGH ST
BUFFALO NY
14203-1149
US

IV. Provider business mailing address

425 ESSJAY RD STE 170
WILLIAMSVILLE NY
14221-5782
US

V. Phone/Fax

Practice location:
  • Phone: 716-862-1969
  • Fax: 716-630-1348
Mailing address:
  • Phone: 716-630-1219
  • Fax: 171-681-7172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: