Provider Demographics
NPI:1700817087
Name:NICHTER, SUSAN M (PA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:NICHTER
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 1:425 ESSJAY RD
Mailing Address - Street 2:STE 170
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5782
Mailing Address - Country:US
Mailing Address - Phone:716-630-1219
Mailing Address - Fax:
Practice Address - Street 1:325 ESSJAY RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-8243
Practice Address - Country:US
Practice Address - Phone:716-630-1006
Practice Address - Fax:716-250-5922
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008550-1363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00235545OtherRR MEDICARE
NY000570351004OtherHEALTH NOW
NY161000580OtherNORTH AMERICAN PREFERRED
NY00026823902OtherUNIVERA
NY02343768Medicaid
NY161000580OtherNOVA
NY9512736OtherIHA
NY00026823902OtherUNIVERA
NY161000580OtherNORTH AMERICAN PREFERRED