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General NPI Number Information
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NPI Number | 1417058298
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Entity Type | Individual
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Provider Name | HEATHER LYNN BAILEY PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 10/27/2011
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Provider Practice Location Address
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Address Line | 656 ELMWOOD AVE
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City | BUFFALO
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State | NY
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Zip | 14222-1836
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Country | US
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Telephone | 716-883-0515
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Fax | 716-883-8764
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Provider Business Mailing Address
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Address Line | 656 ELMWOOD AVE
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City | BUFFALO
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State | NY
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Zip | 14222-1836
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Country | US
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Telephone | 716-883-0515
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Fax | 716-883-8764
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0101091NYS
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License Number State | NY
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