Healthcare Provider Details

I. General information

NPI: 1407160997
Provider Name (Legal Business Name): MEGAN C DONNELLY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 ORCHARD PARK RD. SUITE B103
WEST SENECA NY
14224-2654
US

IV. Provider business mailing address

550 ORCHARD PARK RD. SUITE A105
WEST SENECA NY
14224-2654
US

V. Phone/Fax

Practice location:
  • Phone: 716-677-5005
  • Fax: 716-712-0160
Mailing address:
  • Phone: 716-677-6000
  • Fax: 716-677-6006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number014027
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number014027
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: