Provider Demographics
NPI:1689961054
Name:BROWN, RACHEL M (PA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:M
Other - Last Name:DULSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1500 TOWN LINE RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-9705
Mailing Address - Country:US
Mailing Address - Phone:716-364-0025
Mailing Address - Fax:
Practice Address - Street 1:6245 SHERIDAN DR
Practice Address - Street 2:SUITE 116
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-4834
Practice Address - Country:US
Practice Address - Phone:176-472-9204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014871363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03410304Medicaid
J400051028Medicare PIN