Provider Demographics
NPI:1104235274
Name:GAWORECKI, LINDSEY ANN (PA)
Entity type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:ANN
Last Name:GAWORECKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:LINDSEY
Other - Middle Name:ANN
Other - Last Name:SAMPO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3107 EAST GENESEE STREET
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224
Mailing Address - Country:US
Mailing Address - Phone:315-299-5313
Mailing Address - Fax:315-299-5661
Practice Address - Street 1:3107 EAST GENESEE STREET
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13224
Practice Address - Country:US
Practice Address - Phone:315-299-5313
Practice Address - Fax:315-299-5661
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017811363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical