MEDICARE: TIFFANY ALI

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	363AM0700X	Medical Physician Assistant	9620	AZ
2	363AM0700X	Medical Physician Assistant	018806-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083090294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY ALI

Provider Business Mailing Address
First Line	:	1150 YOUNGS RD STE 104
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-8096
Country	:	US
Telephone Number	:	716-636-7990
Fax Number	:	716-636-7992

Provider Business Practice Location Address
First Line	:	3950 E ROBINSON RD STE 207
Second Line	:
City	:	WEST AMHERST
State	:	NY
Zip	:	14228-2044
Country	:	US
Telephone Number	:	716-564-1111
Fax Number	:	716-929-0194

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

Provider Enumeration Date	:	08/11/2015
Last Update Date	:	11/01/2023

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Directions to “ TIFFANY ALI ” Practice Location

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