Healthcare Provider Details

I. General information

NPI: 1922785443
Provider Name (Legal Business Name): MADELINE EMMI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 N BUFFALO ST
ORCHARD PARK NY
14127-1842
US

IV. Provider business mailing address

425 ESSJAY RD STE 170
WILLIAMSVILLE NY
14221-8235
US

V. Phone/Fax

Practice location:
  • Phone: 716-631-2517
  • Fax: 716-634-5650
Mailing address:
  • Phone: 716-630-1219
  • Fax: 716-817-1726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: