Provider Demographics
NPI:1508179045
Name:DENUE, CHELSEA R (PA)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:R
Last Name:DENUE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:R
Other - Last Name:DENN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:4711 TRANSIT RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-4888
Mailing Address - Country:US
Mailing Address - Phone:716-668-5331
Mailing Address - Fax:716-668-5370
Practice Address - Street 1:4711 TRANSIT RD
Practice Address - Street 2:SUITE 1
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-4888
Practice Address - Country:US
Practice Address - Phone:716-668-5331
Practice Address - Fax:716-668-5370
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2014-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014114363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03252760Medicaid