Healthcare Provider Details

I. General information

NPI: 1386321743
Provider Name (Legal Business Name): JENNIFER STAWICKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 HARLEM RD
CHEEKTOWAGA NY
14225-4031
US

IV. Provider business mailing address

13514 SCHANG RD
EAST AURORA NY
14052-9500
US

V. Phone/Fax

Practice location:
  • Phone: 716-893-0333
  • Fax:
Mailing address:
  • Phone: 716-426-9419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number030037
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: