Provider Demographics
NPI:1700942174
Name:DEANGELIS, MALIA (PA)
Entity Type:Individual
Prefix:
First Name:MALIA
Middle Name:
Last Name:DEANGELIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3980 SHERIDAN DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1727
Mailing Address - Country:US
Mailing Address - Phone:716-250-2000
Mailing Address - Fax:716-250-2040
Practice Address - Street 1:3980 SHERIDAN DR
Practice Address - Street 2:SUITE 200
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1727
Practice Address - Country:US
Practice Address - Phone:716-250-2000
Practice Address - Fax:716-636-1365
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0100741363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00026953001OtherUNIVERA
NY000570515002OtherBLUE CROSS & BLUE SHIELD
NY02631354Medicaid
NY000570515001OtherBLUE CROSS & BLUE SHIELD
NY9512745OtherINDEPENDENT HEALTH
NY9512745OtherINDEPENDENT HEALTH
NY00026953001OtherUNIVERA