Provider Demographics
NPI:1033237292
Name:GELOFF, BRENDA A (PA)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:A
Last Name:GELOFF
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 E. ADAMS STREET
Mailing Address - Street 2:5TH FL
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210
Mailing Address - Country:US
Mailing Address - Phone:315-464-5726
Mailing Address - Fax:
Practice Address - Street 1:725 E. ADAMS STREET
Practice Address - Street 2:5TH FL
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-464-5726
Practice Address - Fax:315-475-2909
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0057921363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant