Provider Demographics
NPI:1811392632
Name:PIACENTINI, OLIVIA SOPHIA (PA)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:SOPHIA
Last Name:PIACENTINI
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 1:229 SUMMIT ST STE 4
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-1645
Mailing Address - Country:US
Mailing Address - Phone:585-344-5470
Mailing Address - Fax:585-344-7451
Practice Address - Street 1:229 SUMMIT ST STE 4
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1645
Practice Address - Country:US
Practice Address - Phone:585-344-5470
Practice Address - Fax:585-344-7451
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017773363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400176013/GRP70008AMedicare PIN
NYJ400176011/GRPBA0017Medicare PIN