MEDICARE: MS. ANGELINA M MISENO-CALLAGHAN RPA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	009607	NY
2	363AM0700X	Medical Physician Assistant	009607	NY
3	363A00000X	Physician Assistant	5601007026	MI

General Provider Information

NPI Number	:	1073505285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELINA M MISENO-CALLAGHAN RPA-C

Provider Business Mailing Address
First Line	:	PO BOX 500
Second Line	:
City	:	ELLICOTTVILLE
State	:	NY
Zip	:	14731-0500
Country	:	US
Telephone Number	:	716-699-9032
Fax Number	:	716-369-9590

Provider Business Practice Location Address
First Line	:	1694 ROUTE 9
Second Line	:
City	:	HALFMOON
State	:	NY
Zip	:	12065-8816
Country	:	US
Telephone Number	:	518-930-7486
Fax Number	:	518-930-7487

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	02/05/2021

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