Healthcare Provider Details

I. General information

NPI: 1982920898
Provider Name (Legal Business Name): DESSIALIS CRUZ RPA-C, MPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2010
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 BARTON ST
BUFFALO NY
14213-1573
US

IV. Provider business mailing address

184 BARTON ST
BUFFALO NY
14213-1573
US

V. Phone/Fax

Practice location:
  • Phone: 716-881-6191
  • Fax: 716-881-6247
Mailing address:
  • Phone: 716-881-6191
  • Fax: 716-881-6247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number013943-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: