Provider Demographics
NPI:1821532169
Name:PANEBIANCO, GRACE (MD)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:
Last Name:PANEBIANCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:CERAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:20 SPRINGDALE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-8528
Mailing Address - Country:US
Mailing Address - Phone:716-969-4659
Mailing Address - Fax:
Practice Address - Street 1:20 SPRINGDALE AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-8528
Practice Address - Country:US
Practice Address - Phone:716-969-4659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist