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: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10988 BENNETT STATE RD
FORESTVILLE NY
14062-9714
US

IV. Provider business mailing address

107 INSTITUTE ST
JAMESTOWN NY
14701-6628
US

V. Phone/Fax

Practice location:
  • Phone: 716-732-7770
  • Fax:
Mailing address:
  • Phone: 716-484-4334
  • Fax:

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: