Provider Demographics
NPI:1710311923
Name:SIBIGA, LAURALEE (PA-C)
Entity Type:Individual
Prefix:
First Name:LAURALEE
Middle Name:
Last Name:SIBIGA
Suffix:
Gender:F
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 1:1 SCHOOL ST STE 107
Mailing Address - Street 2:
Mailing Address - City:GOWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14070-1143
Mailing Address - Country:US
Mailing Address - Phone:716-241-7067
Mailing Address - Fax:833-464-5024
Practice Address - Street 1:1 SCHOOL ST STE 107
Practice Address - Street 2:
Practice Address - City:GOWANDA
Practice Address - State:NY
Practice Address - Zip Code:14070-1143
Practice Address - Country:US
Practice Address - Phone:716-241-7067
Practice Address - Fax:833-464-5024
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016717363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant