Healthcare Provider Details

I. General information

NPI: 1750350278
Provider Name (Legal Business Name): PATRICIA WHEELER P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 RED JACKET ST
DANSVILLE NY
14437-9502
US

IV. Provider business mailing address

PO BOX 499 22 RED JACKET STREET
DANSVILLE NY
14437-0499
US

V. Phone/Fax

Practice location:
  • Phone: 585-335-5200
  • Fax: 585-335-5037
Mailing address:
  • Phone: 585-335-5200
  • Fax: 585-335-5037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002095
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: