Provider Demographics
NPI:1962468413
Name:PALAZZO, ROSE THERESA (PA)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:THERESA
Last Name:PALAZZO
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 1:338 HARRIS HILL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7407
Mailing Address - Country:US
Mailing Address - Phone:716-634-9303
Mailing Address - Fax:716-634-9502
Practice Address - Street 1:6095 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-1803
Practice Address - Country:US
Practice Address - Phone:716-634-9351
Practice Address - Fax:716-688-6716
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYR06911363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR0B911Medicare UPIN