Provider Demographics
NPI:1164730339
Name:KAMINSKA, STEPHANIE NICOLE (PA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:NICOLE
Last Name:KAMINSKA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:NICOLE
Other - Last Name:KOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:8750 TRANSIT RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-2610
Mailing Address - Country:US
Mailing Address - Phone:716-636-1470
Mailing Address - Fax:888-886-2563
Practice Address - Street 1:8750 TRANSIT RD
Practice Address - Street 2:SUITE 105
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-2610
Practice Address - Country:US
Practice Address - Phone:716-636-1470
Practice Address - Fax:888-886-2563
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014158363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY014158OtherNYS PROFESSIONAL LICENSE