Provider Demographics
NPI:1679676456
Name:GILLESPIE, JOYCE F (PA)
Entity Type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:F
Last Name:GILLESPIE
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 1:51 COOKS CT
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12188-1167
Mailing Address - Country:US
Mailing Address - Phone:518-371-0813
Mailing Address - Fax:
Practice Address - Street 1:532 MOE RD
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3822
Practice Address - Country:US
Practice Address - Phone:518-383-2425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003342-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant