Provider Demographics
NPI:1134772379
Name:DEE, MATTHEW M (PA-C)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:M
Last Name:DEE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 554
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:NY
Mailing Address - Zip Code:14031-0554
Mailing Address - Country:US
Mailing Address - Phone:716-759-7759
Mailing Address - Fax:716-759-1759
Practice Address - Street 1:9276 MAIN ST STE 1A
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031-1969
Practice Address - Country:US
Practice Address - Phone:716-759-7759
Practice Address - Fax:716-759-1759
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023584363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant