Healthcare Provider Details

I. General information

NPI: 1912817461
Provider Name (Legal Business Name): CAMERON ELLIS JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CLARA BARTON ST
DANSVILLE NY
14437-9503
US

IV. Provider business mailing address

11143 YOCUM RD
WAYLAND NY
14572-9554
US

V. Phone/Fax

Practice location:
  • Phone: 585-335-6001
  • Fax:
Mailing address:
  • Phone: 585-269-8343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number036571
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number036571
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: