Provider Demographics
NPI:1164688222
Name:SENDLAK, ELIZABETH MARIE (R-PAC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARIE
Last Name:SENDLAK
Suffix:
Gender:F
Credentials:R-PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 YOUNGS RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2644
Mailing Address - Country:US
Mailing Address - Phone:716-688-7344
Mailing Address - Fax:716-688-7345
Practice Address - Street 1:1000 YOUNGS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2644
Practice Address - Country:US
Practice Address - Phone:716-688-7344
Practice Address - Fax:716-688-7345
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012644363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant