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General NPI Number Information
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NPI Number | 1083989461
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Entity Type | Individual
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Provider Name | KELLI GRIECO RPA-C
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Gender | Female
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Dates
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Enumeration Date | 03/19/2012
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Last Update Date | 09/13/2019
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Provider Practice Location Address
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Address Line | 1829 MAPLE RD SUITE 201
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-2700
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Country | US
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Telephone | 716-839-7107
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Fax |
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Provider Business Mailing Address
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Address Line | 3925 SHERIDAN DR STE 100
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City | AMHERST
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State | NY
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Zip | 14226-1738
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Country | US
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Telephone | 716-250-6492
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Fax | 716-250-6522
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 015489
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License Number State | NY
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