Healthcare Provider Details

I. General information

NPI: 1619379062
Provider Name (Legal Business Name): RACHEL ELIZABETH RAGOSTA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 FOOTE AVE
JAMESTOWN NY
14701
US

IV. Provider business mailing address

2535 SUNNYSIDE RD
FINDLEY LAKE NY
14736-9717
US

V. Phone/Fax

Practice location:
  • Phone: 716-485-7892
  • Fax: 716-487-1802
Mailing address:
  • Phone: 208-651-8616
  • Fax: 716-487-1802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-1458
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA60504943
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: