Provider Demographics
NPI:1083989461
Name:GRIECO, KELLI (RPA-C)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:GRIECO
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 SHERIDAN DR
Mailing Address - Street 2:STE 100
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1738
Mailing Address - Country:US
Mailing Address - Phone:716-250-6492
Mailing Address - Fax:716-250-6522
Practice Address - Street 1:1829 MAPLE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2700
Practice Address - Country:US
Practice Address - Phone:716-839-7107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015489363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant