Provider Demographics
NPI:1790055523
Name:GRAVES, JULIANA ELLEN (PA)
Entity Type:Individual
Prefix:MRS
First Name:JULIANA
Middle Name:ELLEN
Last Name:GRAVES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:664 STONELEIGH AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-3990
Mailing Address - Country:US
Mailing Address - Phone:845-230-5136
Mailing Address - Fax:845-278-4320
Practice Address - Street 1:664 STONELEIGH AVE STE 300
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512
Practice Address - Country:US
Practice Address - Phone:845-278-8400
Practice Address - Fax:845-278-4320
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY015006363A00000X
CT4388363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant