Provider Demographics
NPI:1306968243
Name:SMALL-CANGIALOSI, SHIRA (PA-C)
Entity type:Individual
Prefix:MS
First Name:SHIRA
Middle Name:
Last Name:SMALL-CANGIALOSI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:SHIRA
Other - Middle Name:
Other - Last Name:SMALL-CANGIALOSI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:1 ATWELL RD
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-1301
Mailing Address - Country:US
Mailing Address - Phone:607-547-3480
Mailing Address - Fax:
Practice Address - Street 1:739 STATE HIGHWAY 28 STE 9
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-3590
Practice Address - Country:US
Practice Address - Phone:607-431-1015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007426363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical