Provider Demographics
NPI:1295224731
Name:GRIMALDI, GABRIELLE (PA)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:GRIMALDI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:30 N UNION RD STE 102
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5367
Mailing Address - Country:US
Mailing Address - Phone:716-839-8000
Mailing Address - Fax:716-839-8009
Practice Address - Street 1:3040 AMSDELL RD
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-5835
Practice Address - Country:US
Practice Address - Phone:716-646-6700
Practice Address - Fax:716-646-8515
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2021-11-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05221816Medicaid