Healthcare Provider Details

I. General information

NPI: 1083090294
Provider Name (Legal Business Name): TIFFANY ALI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 E ROBINSON RD STE 207
WEST AMHERST NY
14228-2044
US

IV. Provider business mailing address

1150 YOUNGS RD STE 104
WILLIAMSVILLE NY
14221-8096
US

V. Phone/Fax

Practice location:
  • Phone: 716-564-1111
  • Fax: 716-929-0194
Mailing address:
  • Phone: 716-636-7990
  • Fax: 716-636-7992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9620
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number018806-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: