Provider Demographics
NPI:1326148404
Name:SORRENTINO, LISA A (PA)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:A
Last Name:SORRENTINO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:PHILLIANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:275 NORTHPOINTE PARKWAY
Mailing Address - Street 2:SUITE 50
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228
Mailing Address - Country:US
Mailing Address - Phone:716-834-1191
Mailing Address - Fax:716-923-4380
Practice Address - Street 1:1440 MAPLE ROAD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-568-3600
Practice Address - Fax:716-923-4384
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011299-1363A00000X
NY011299363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000528916002OtherBCBS
NY02839196Medicaid
NY197646BJOtherPREFERRED CARE
NY9514041OtherINDEPENDENT HEALTH
NY00027798902OtherUNIVERA
NY00027798901OtherUNIVERA
NY000528916001OtherBCBS
NY070209000070OtherFIDELIS
NY00027798901OtherUNIVERA
NY197646BJOtherPREFERRED CARE
NY02839196Medicaid
NYPA1790Medicare PIN