Provider Demographics
NPI:1366447765
Name:MUNRO, AMY JEANENE (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JEANENE
Last Name:MUNRO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3884 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-1104
Mailing Address - Country:US
Mailing Address - Phone:716-681-9000
Mailing Address - Fax:716-256-1079
Practice Address - Street 1:3884 BROADWAY
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-1104
Practice Address - Country:US
Practice Address - Phone:716-981-9000
Practice Address - Fax:716-256-1079
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008116-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0945293OtherCIGN
NY113653686118OtherTODAY'S OPTION
NY02345504Medicaid
NY1039551OtherWELLCARE
NY9776524OtherAETNA
NYPC139377OtherMVP
NY9776524OtherAETNA