Provider Demographics
NPI:1215491600
Name:PHILLIPPI, AMBER L
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:L
Last Name:PHILLIPPI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 PARK CLUB LN
Mailing Address - Street 2:STE 300
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5269
Mailing Address - Country:US
Mailing Address - Phone:716-836-4646
Mailing Address - Fax:716-836-4696
Practice Address - Street 1:19 LIMESTONE DR STE 11
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7091
Practice Address - Country:US
Practice Address - Phone:716-634-3500
Practice Address - Fax:716-634-3525
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023215363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant