Provider Demographics
NPI:1700055068
Name:DERANEY, TREVOR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:
Last Name:DERANEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14240-0488
Mailing Address - Country:US
Mailing Address - Phone:203-944-1940
Mailing Address - Fax:203-402-4192
Practice Address - Street 1:237 LINWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-2009
Practice Address - Country:US
Practice Address - Phone:716-248-1420
Practice Address - Fax:716-248-2026
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022142363A00000X
FLPA 9104519363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020626400Medicaid
NY03217214Medicaid