MEDICARE: SAMANTHA ANNE OLEWNIK PA-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	363A00000X	Physician Assistant	0010-05906	NC
2	363A00000X	Physician Assistant	014054	NY

General Provider Information

NPI Number	:	1184936833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA ANNE OLEWNIK PA-C

Provider Business Mailing Address
First Line	:	2350 MAPLE RD
Second Line	:	STE 100
City	:	BUFFALO
State	:	NY
Zip	:	14221-4080
Country	:	US
Telephone Number	:	716-688-6500
Fax Number	:

Provider Business Practice Location Address
First Line	:	2350 MAPLE RD STE 100
Second Line	:
City	:	AMHERST
State	:	NY
Zip	:	14221-4080
Country	:	US
Telephone Number	:	716-688-6500
Fax Number	:	716-688-6501

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

Provider Enumeration Date	:	07/10/2010
Last Update Date	:	06/02/2020

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