Provider Demographics
NPI:1063594067
Name:WHEELER, TAMMY HELLMAN (PA)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:HELLMAN
Last Name:WHEELER
Suffix:
Gender:F
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:PO BOX 14890
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:518-525-5634
Mailing Address - Fax:518-649-4094
Practice Address - Street 1:11 HAMPSTEAD PL N STE 103
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-5669
Practice Address - Country:US
Practice Address - Phone:518-583-7400
Practice Address - Fax:518-583-7425
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2021-06-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY0060831363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02347515Medicaid
NYS73403Medicare UPIN