Provider Demographics
NPI:1104099233
Name:O'LEARY, DENIECE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:DENIECE
Middle Name:
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 VETERANS MEMORIAL HWY UNIT 141
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-6408
Mailing Address - Country:US
Mailing Address - Phone:289-400-4499
Mailing Address - Fax:
Practice Address - Street 1:257 STATE ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1044
Practice Address - Country:US
Practice Address - Phone:585-343-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17591363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical