Healthcare Provider Details

I. General information

NPI: 1942758438
Provider Name (Legal Business Name): ALEXIS DIANE SAIA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXIS DIANE HARGRAVE PA

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1783 ROUTE 9 STE 204
HALFMOON NY
12065-2466
US

IV. Provider business mailing address

6 WELLNESS WAY STE 201
LATHAM NY
12110-2156
US

V. Phone/Fax

Practice location:
  • Phone: 518-371-9355
  • Fax: 518-373-9139
Mailing address:
  • Phone: 518-782-3700
  • Fax: 518-782-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number020224
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: