Provider Demographics
NPI:1033899398
Name:FELLOWS, EMMA LAUREN (PA-C)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:LAUREN
Last Name:FELLOWS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 33RD ST APT 28G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4832
Mailing Address - Country:US
Mailing Address - Phone:248-880-7777
Mailing Address - Fax:
Practice Address - Street 1:200 E 33RD ST APT 28G
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4832
Practice Address - Country:US
Practice Address - Phone:248-880-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030143363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant