Provider Demographics
NPI:1346675204
Name:RE, ASHLEY ELOISE (RPA-C)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ELOISE
Last Name:RE
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:E
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:818 ELLICOTT ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1021
Mailing Address - Country:US
Mailing Address - Phone:716-323-2000
Mailing Address - Fax:
Practice Address - Street 1:818 ELLICOTT ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1021
Practice Address - Country:US
Practice Address - Phone:716-323-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016899363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03746325Medicaid
NY150624000031OtherFIDELIS
NYPAROtherBC OF WNY
NYPAROtherYOURCARE
NY00026794502OtherUNIVERA