Healthcare Provider Details

I. General information

NPI: 1447547310
Provider Name (Legal Business Name): MANDY LYNN ABRAM RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MANDY LYNN HORNBERGER RPA-C

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 YOUNGS RD SUITE104
WILLIAMSVILLE NY
14221-8053
US

IV. Provider business mailing address

1150 YOUNGS RD SUITE104
WILLIAMSVILLE NY
14221-8053
US

V. Phone/Fax

Practice location:
  • Phone: 716-636-7979
  • Fax: 716-636-7993
Mailing address:
  • Phone: 716-636-7979
  • Fax: 716-636-7993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number014845
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: