Provider Demographics
NPI:1851404917
Name:LAUDISIO, ANDREA (PA)
Entity Type:Individual
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First Name:ANDREA
Middle Name:
Last Name:LAUDISIO
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Gender:F
Credentials:PA
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Mailing Address - Street 1:755 JEFFERSON RD
Mailing Address - Street 2:STE 110
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-3270
Mailing Address - Country:US
Mailing Address - Phone:585-419-7948
Mailing Address - Fax:585-385-6071
Practice Address - Street 1:3980 SHERIDAN DR
Practice Address - Street 2:SUITE 200
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1727
Practice Address - Country:US
Practice Address - Phone:716-250-2000
Practice Address - Fax:716-636-1365
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2019-02-20
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Provider Licenses
StateLicense IDTaxonomies
NY008918363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P95768Medicare UPIN