Provider Demographics
NPI:1578658613
Name:CIESLA, TERA MICHELLE (RPA-C)
Entity Type:Individual
Prefix:
First Name:TERA
Middle Name:MICHELLE
Last Name:CIESLA
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4511 HARLEM RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3822
Mailing Address - Country:US
Mailing Address - Phone:716-839-6720
Mailing Address - Fax:716-839-6740
Practice Address - Street 1:219 BRYANT ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-2006
Practice Address - Country:US
Practice Address - Phone:716-878-7442
Practice Address - Fax:716-878-7101
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008754363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
000570437002OtherBC/BS
9511829OtherIHA
FIDELISOther050711000014
UNIVERAOther00026559809
NY02504589Medicaid
000570437002OtherBC/BS
UNIVERAOther00026559809