Provider Demographics
NPI:1750741906
Name:GOEDE, ALEXANDRA BENNETT (PNP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:BENNETT
Last Name:GOEDE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 E ROBINSON RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WEST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-2041
Mailing Address - Country:US
Mailing Address - Phone:716-691-3400
Mailing Address - Fax:
Practice Address - Street 1:3950 E ROBINSON RD
Practice Address - Street 2:SUITE 205
Practice Address - City:WEST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2041
Practice Address - Country:US
Practice Address - Phone:716-691-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY686064163W00000X
NYF382624363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse