Provider Demographics
NPI:1164496717
Name:ZAGROBELNY, PAULA (NP)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:ZAGROBELNY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 OLEAN ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-2540
Mailing Address - Country:US
Mailing Address - Phone:716-805-1072
Mailing Address - Fax:716-805-1073
Practice Address - Street 1:112 OLEAN ST
Practice Address - Street 2:SUITE 220
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-2540
Practice Address - Country:US
Practice Address - Phone:716-805-1072
Practice Address - Fax:716-805-1073
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332454363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000560635002OtherBC/BS
NY9512178OtherIHA
NY02345733Medicaid
NY00026703801OtherUNIVERA
DD3572Medicare ID - Type Unspecified
NY02345733Medicaid