Healthcare Provider Details

I. General information

NPI: 1366447765
Provider Name (Legal Business Name): AMY JEANENE MUNRO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 10/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3884 BROADWAY
CHEEKTOWAGA NY
14227-1104
US

IV. Provider business mailing address

3884 BROADWAY
CHEEKTOWAGA NY
14227-1104
US

V. Phone/Fax

Practice location:
  • Phone: 716-981-9000
  • Fax: 716-256-1079
Mailing address:
  • Phone: 716-681-9000
  • Fax: 716-256-1079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number008116-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: