Provider Demographics
NPI:1164441564
Name:MEDICO, CHRISTINA MARY (PNP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:MARY
Last Name:MEDICO
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:171 S ROCKINGHAM WAY
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-3723
Mailing Address - Country:US
Mailing Address - Phone:716-688-6431
Mailing Address - Fax:
Practice Address - Street 1:2625 HARLEM RD STE 210
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4031
Practice Address - Country:US
Practice Address - Phone:716-893-7337
Practice Address - Fax:716-893-7699
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY381670363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics