MEDICARE: MR. DANIEL ANTHONY FELLS 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	363AM0700X	Medical Physician Assistant	010025	NY

General Provider Information

NPI Number	:	1265594840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL ANTHONY FELLS RPA-C

Provider Business Mailing Address
First Line	:	66 CAMELOT CT
Second Line	:	A
City	:	BUFFALO
State	:	NY
Zip	:	14214-1421
Country	:	US
Telephone Number	:	716-832-2451
Fax Number	:

Provider Business Practice Location Address
First Line	:	564 NIAGARA ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14201-1108
Country	:	US
Telephone Number	:	716-882-0366
Fax Number	:

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	07/08/2007

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