Provider Demographics
NPI:1831458603
Name:CASTONGUAY, ANDREA (PA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:CASTONGUAY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4949 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-2500
Mailing Address - Country:US
Mailing Address - Phone:716-204-3200
Mailing Address - Fax:
Practice Address - Street 1:5500 MAIN ST
Practice Address - Street 2:SUITE 107
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6755
Practice Address - Country:US
Practice Address - Phone:716-906-5908
Practice Address - Fax:716-204-4061
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant