Provider Demographics
NPI:1841229432
Name:CODY, WENDY (PA)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:CODY
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 1:4 LAND RE WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559
Mailing Address - Country:US
Mailing Address - Phone:585-368-6620
Mailing Address - Fax:585-368-6621
Practice Address - Street 1:4 LAND RE WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559
Practice Address - Country:US
Practice Address - Phone:585-368-6620
Practice Address - Fax:585-368-6621
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008728363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02413243Medicaid
NY02413243Medicaid
NYPA0036 - GRP: BA0017Medicare PIN
NYPA0036 - GRP: BA0017Medicare PIN