Healthcare Provider Details

I. General information

NPI: 1841294675
Provider Name (Legal Business Name): HARMONY R DEPAN RPAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2741 TRANSIT RD
ELMA NY
14059-9634
US

IV. Provider business mailing address

425 ESSJAY RD STE 170
WILLIAMSVILLE NY
14221-8235
US

V. Phone/Fax

Practice location:
  • Phone: 716-677-6060
  • Fax: 716-677-6078
Mailing address:
  • Phone: 716-630-1219
  • Fax: 716-817-1726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number007348
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: