MEDICARE: MR. ADAM WALTER MIZZI 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	363A00000X	Physician Assistant	011926-1	NY

General Provider Information

NPI Number	:	1396944682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ADAM WALTER MIZZI RPA-C

Provider Business Mailing Address
First Line	:	351 NORTH ST
Second Line	:
City	:	CANANDAIGUA
State	:	NY
Zip	:	14424-1297
Country	:	US
Telephone Number	:	585-975-5125
Fax Number	:	585-393-1663

Provider Business Practice Location Address
First Line	:	351 NORTH ST
Second Line	:
City	:	CANANDAIGUA
State	:	NY
Zip	:	14424-1297
Country	:	US
Telephone Number	:	585-975-5125
Fax Number	:	585-393-1663

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

Provider Enumeration Date	:	07/16/2007
Last Update Date	:	04/27/2026

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