Provider Demographics
NPI:1750698858
Name:MEYERS-STANDLEY, ERICA (PA-C)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:MEYERS-STANDLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:MEYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1 WEST AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-6050
Mailing Address - Country:US
Mailing Address - Phone:518-693-4699
Mailing Address - Fax:518-584-3016
Practice Address - Street 1:1 WEST AVE STE 300
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-6050
Practice Address - Country:US
Practice Address - Phone:518-693-4699
Practice Address - Fax:518-584-3016
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054529363A00000X
NY017115-1363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03760414Medicaid
NY03760414Medicaid