Healthcare Provider Details

I. General information

NPI: 1750082418
Provider Name (Legal Business Name): JULIA MARIE BASHAW PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2023
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26908 INDEPENDENCE WAY
EVANS MILLS NY
13637-3300
US

IV. Provider business mailing address

32380 STATE ROUTE 12E
CAPE VINCENT NY
13618-2100
US

V. Phone/Fax

Practice location:
  • Phone: 315-629-4525
  • Fax: 315-629-5751
Mailing address:
  • Phone: 315-408-3354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number033173
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: