Provider Demographics
NPI:1780050831
Name:BALAZI, JONIDA
Entity type:Individual
Prefix:
First Name:JONIDA
Middle Name:
Last Name:BALAZI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 UNIVERSITY DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2247
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:170 UNIVERSITY DR
Practice Address - Street 2:SUITE 201
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2247
Practice Address - Country:US
Practice Address - Phone:413-253-2767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA5437363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical