Provider Demographics
NPI:1285074856
Name:VASILOFF, ALYSSA CHRISTINE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:CHRISTINE
Last Name:VASILOFF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:CHRISTINE
Other - Last Name:KOONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2991 BRAVURA LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240
Mailing Address - Country:US
Mailing Address - Phone:716-867-8450
Mailing Address - Fax:
Practice Address - Street 1:1 JOHN JAMES AUDUBON PKWY
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-1143
Practice Address - Country:US
Practice Address - Phone:716-204-4500
Practice Address - Fax:716-817-1900
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0166231363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant