Provider Demographics
NPI:1366602369
Name:DERLETH, PAULA MARY (DC)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:MARY
Last Name:DERLETH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 EDENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-1413
Mailing Address - Country:US
Mailing Address - Phone:585-746-0453
Mailing Address - Fax:
Practice Address - Street 1:2 EDENFIELD RD
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-1413
Practice Address - Country:US
Practice Address - Phone:585-746-0453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program