Provider Demographics
NPI:1649513730
Name:COE, ASHLEY ANN (PA)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ANN
Last Name:COE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:ANN
Other - Last Name:BYCZYNSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:77 GOODELL STREET
Mailing Address - Street 2:STE 240
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1243
Mailing Address - Country:US
Mailing Address - Phone:716-645-9694
Mailing Address - Fax:718-845-6699
Practice Address - Street 1:2465 SHERIDAN DRIVE
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-9407
Practice Address - Country:US
Practice Address - Phone:716-835-9800
Practice Address - Fax:716-835-9888
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016474363A00000X
NY016474-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03573104Medicaid