Provider Demographics
NPI:1851346225
Name:MAGAI, COLLEEN SONDRA (RPA-C)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:SONDRA
Last Name:MAGAI
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5930
Mailing Address - Country:US
Mailing Address - Phone:315-801-3282
Mailing Address - Fax:315-801-8391
Practice Address - Street 1:1104 LOGTOWN RD
Practice Address - Street 2:
Practice Address - City:FULTONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12072-2642
Practice Address - Country:US
Practice Address - Phone:518-922-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007669-01363A00000X
NY007669363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02743277Medicaid
NY02743277Medicaid
NY0L5L6Medicare ID - Type UnspecifiedDOWNSTATE
NYQ23033Medicare UPIN