Provider Demographics
NPI:1073505285
Name:MISENO-CALLAGHAN, ANGELINA M (RPA-C)
Entity type:Individual
Prefix:MS
First Name:ANGELINA
Middle Name:M
Last Name:MISENO-CALLAGHAN
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:MS
Other - First Name:ANGELINA
Other - Middle Name:M
Other - Last Name:CAMINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:ELLICOTTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14731-0500
Mailing Address - Country:US
Mailing Address - Phone:716-699-9032
Mailing Address - Fax:716-369-9590
Practice Address - Street 1:1694 ROUTE 9
Practice Address - Street 2:
Practice Address - City:HALFMOON
Practice Address - State:NY
Practice Address - Zip Code:12065-8816
Practice Address - Country:US
Practice Address - Phone:518-930-7486
Practice Address - Fax:518-930-7487
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009607207Q00000X, 363AM0700X
MI5601007026363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q21040Medicare UPIN
NYPA0776Medicare ID - Type Unspecified