Healthcare Provider Details

I. General information

NPI: 1659739936
Provider Name (Legal Business Name): CRYSTAL ANN DENSMORE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2731 TRANSIT RD. STE 107
ELMA NY
14059
US

IV. Provider business mailing address

2731 TRANSIT RD. STE 107
ELMA NY
14059
US

V. Phone/Fax

Practice location:
  • Phone: 716-677-4178
  • Fax: 855-816-9607
Mailing address:
  • Phone: 716-677-4178
  • Fax: 855-816-9607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number019539
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberP00752
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: