Provider Demographics
NPI:1568450989
Name:SANTIAGO, JASON A (PA)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:A
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:3980 SHERIDAN DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1727
Mailing Address - Country:US
Mailing Address - Phone:716-250-2000
Mailing Address - Fax:716-250-2040
Practice Address - Street 1:3980 SHERIDAN DR
Practice Address - Street 2:SUITE 200
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1727
Practice Address - Country:US
Practice Address - Phone:716-250-2000
Practice Address - Fax:716-636-1365
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY010584363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY061018000088OtherFIDELIS
NY9512962OtherINDEPENDENT HEALTH