Provider Demographics
NPI:1598773194
Name:SWAIN, STEPHEN PATRICK (PA)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:PATRICK
Last Name:SWAIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4231 OLD HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7618
Mailing Address - Country:US
Mailing Address - Phone:716-634-6570
Mailing Address - Fax:
Practice Address - Street 1:VAWNY HEALTHCARE SYSTEM
Practice Address - Street 2:3495 BAILEY AVE
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215
Practice Address - Country:US
Practice Address - Phone:716-862-8774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008737363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant