Provider Demographics
NPI:1780685800
Name:DIGIULIO, LAURA N (PA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:N
Last Name:DIGIULIO
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 1:90 PRESTONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1687
Mailing Address - Country:US
Mailing Address - Phone:716-636-4150
Mailing Address - Fax:
Practice Address - Street 1:3615 SENECA ST
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3444
Practice Address - Country:US
Practice Address - Phone:716-675-2660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008150-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CC7375Medicare ID - Type Unspecified
NYP63913Medicare UPIN