Provider Demographics
NPI:1457333296
Name:WUTZ, CHERYL ANN (RPA-C)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:WUTZ
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8750 TRANSIT RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-2610
Mailing Address - Country:US
Mailing Address - Phone:716-636-1470
Mailing Address - Fax:716-636-1423
Practice Address - Street 1:8750 TRANSIT RD
Practice Address - Street 2:SUITE 105
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-2610
Practice Address - Country:US
Practice Address - Phone:716-636-1470
Practice Address - Fax:716-636-1423
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003533363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD7174Medicare ID - Type UnspecifiedMEDICARE #
NYR53937Medicare UPIN