Provider Demographics
NPI:1932114642
Name:DZIULKO, AMEY R (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:AMEY
Middle Name:R
Last Name:DZIULKO
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:908 NIAGARA FALLS BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120
Mailing Address - Country:US
Mailing Address - Phone:716-692-2160
Mailing Address - Fax:716-213-0935
Practice Address - Street 1:100 HIGH STREET
Practice Address - Street 2:SECTION B-2
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203
Practice Address - Country:US
Practice Address - Phone:716-710-8266
Practice Address - Fax:716-710-8267
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY006624-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000570173003OtherHEALTH NOW
NY9512201OtherIHA
NY02074899Medicaid
NY161000580OtherNOVA
NY00026554801OtherUNIVERA
NYS58840Medicare UPIN
NY161000580OtherNOVA