Provider Demographics
NPI:1356391395
Name:MITCHELL, JESSICA (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:104 WIMBLEDON CT
Mailing Address - Street 2:APT 7
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1931
Mailing Address - Country:US
Mailing Address - Phone:585-322-4976
Mailing Address - Fax:
Practice Address - Street 1:3085 HARLEM RD
Practice Address - Street 2:SUITE 350
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-2591
Practice Address - Country:US
Practice Address - Phone:716-844-5600
Practice Address - Fax:716-844-5750
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2016-09-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY008272363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPA1371Medicare PIN
NYP70730Medicare UPIN