Provider Demographics
NPI:1679125405
Name:LABEDZ, MIRANDA (PA)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:LABEDZ
Suffix:
Gender:F
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:UNIVERSITY ORTHOPAEDIC SERVICES INC.
Mailing Address - Street 2:4225 GENESEE STREET
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225
Mailing Address - Country:US
Mailing Address - Phone:716-204-3200
Mailing Address - Fax:
Practice Address - Street 1:5959 BIG TREE RD STE 108
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2291
Practice Address - Country:US
Practice Address - Phone:716-204-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY023645OtherNYS OFFICE OF THE PROFESSIONS