Provider Demographics
NPI:1942854500
Name:ZACCAGNINO, CORRIN (PA)
Entity Type:Individual
Prefix:
First Name:CORRIN
Middle Name:
Last Name:ZACCAGNINO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3925 SHERIDAN DR
Mailing Address - Street 2:STE 100
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1738
Mailing Address - Country:US
Mailing Address - Phone:716-250-6492
Mailing Address - Fax:716-250-6522
Practice Address - Street 1:8750 TRANSIT RD STE 105
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-2610
Practice Address - Country:US
Practice Address - Phone:716-636-1470
Practice Address - Fax:716-636-1423
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2019-09-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY023598363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical