Provider Demographics
NPI:1326382631
Name:DI PALMA, ALEXIS C (DNP, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:C
Last Name:DI PALMA
Suffix:
Gender:F
Credentials:DNP, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-1132
Mailing Address - Country:US
Mailing Address - Phone:716-672-6117
Mailing Address - Fax:
Practice Address - Street 1:400 FOREST AVE BLDG 51
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-1207
Practice Address - Country:US
Practice Address - Phone:716-816-2445
Practice Address - Fax:716-816-2357
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY631277-1163WP0808X
NY403058363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY146013200Medicaid