Provider Demographics
NPI:1184936833
Name:OLEWNIK, SAMANTHA ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ANNE
Last Name:OLEWNIK
Suffix:
Gender:F
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 1:2350 MAPLE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4080
Mailing Address - Country:US
Mailing Address - Phone:716-688-6500
Mailing Address - Fax:
Practice Address - Street 1:2350 MAPLE RD STE 100
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14221-4080
Practice Address - Country:US
Practice Address - Phone:716-688-6500
Practice Address - Fax:716-688-6501
Is Sole Proprietor?:No
Enumeration Date:2010-07-10
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05906363A00000X
NY014054363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400024491Medicare PIN
NY03251672Medicaid