Provider Demographics
NPI:1508866054
Name:GIUFFRIDA, LASHAWNDA LATRICE (RPAC)
Entity Type:Individual
Prefix:MRS
First Name:LASHAWNDA
Middle Name:LATRICE
Last Name:GIUFFRIDA
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5613
Mailing Address - Country:US
Mailing Address - Phone:315-725-1012
Mailing Address - Fax:315-724-5219
Practice Address - Street 1:1703 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-5613
Practice Address - Country:US
Practice Address - Phone:315-725-1012
Practice Address - Fax:315-724-5219
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008408363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPA2052Medicare UPIN