Provider Demographics
NPI:1306840285
Name:SMITH, AUDREY DOREEN (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:DOREEN
Last Name:SMITH
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 N UNION RD
Mailing Address - Street 2:STE 104
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5367
Mailing Address - Country:US
Mailing Address - Phone:716-565-3990
Mailing Address - Fax:716-565-3988
Practice Address - Street 1:30 N UNION RD
Practice Address - Street 2:STE 104
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5367
Practice Address - Country:US
Practice Address - Phone:716-565-3990
Practice Address - Fax:716-565-3988
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078191363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPA1451Medicare UPIN