Provider Demographics
NPI:1215626353
Name:MYERS, OLIVIA D (PA)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:D
Last Name:MYERS
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Gender:F
Credentials:PA
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Mailing Address - Street 1:251 SALINA MEADOWS PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212
Mailing Address - Country:US
Mailing Address - Phone:315-464-2000
Mailing Address - Fax:315-464-2010
Practice Address - Street 1:4900 BROAD ROAD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215
Practice Address - Country:US
Practice Address - Phone:315-492-5899
Practice Address - Fax:315-492-5627
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2023-12-01
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Provider Licenses
StateLicense IDTaxonomies
NY030449363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant