Healthcare Provider Details

I. General information

NPI: 1508477472
Provider Name (Legal Business Name): ALEXANDRA PAMELA GALVANO PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6507 TRANSIT RD
EAST AMHERST NY
14051-1427
US

IV. Provider business mailing address

3050 ORCHARD PARK RD
WEST SENECA NY
14224-4658
US

V. Phone/Fax

Practice location:
  • Phone: 716-689-4377
  • Fax:
Mailing address:
  • Phone: 716-675-5222
  • Fax: 716-675-9329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number025429
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: