=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447132857
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHTON ALEXIS RILEY PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2025
-----------------------------------------------------
Last Update Date | 07/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 94 OLEAN ST
-----------------------------------------------------
City | EAST AURORA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14052-2531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-652-0237
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1034 BLAKELEY RD
-----------------------------------------------------
City | EAST AURORA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14052-9717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 034068
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------