Provider Demographics
NPI:1043305246
Name:FELLENZ, MONICA E (PA)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:E
Last Name:FELLENZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:987 R C HOAG DR
Mailing Address - Street 2:
Mailing Address - City:SALAMANCA
Mailing Address - State:NY
Mailing Address - Zip Code:14779-1365
Mailing Address - Country:US
Mailing Address - Phone:716-532-5582
Mailing Address - Fax:716-242-6345
Practice Address - Street 1:275 THOMAS INDIAN SCHOOL DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:NY
Practice Address - Zip Code:14081-9341
Practice Address - Country:US
Practice Address - Phone:716-532-5582
Practice Address - Fax:716-242-6344
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY008548363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY060822000001OtherFIDELIS CARE NEW YORK
NY000528450001OtherWNYBCBS
NY9513195OtherINDEPENDENT HEALTH
NY03479792Medicaid
NCP84431Medicare UPIN
NYPA1325Medicare PIN