Provider Demographics
NPI:1457035651
Name:ROBEL, MALLORY NOELLE (PA-C)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:NOELLE
Last Name:ROBEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9341 STATE RD
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:14069-9601
Mailing Address - Country:US
Mailing Address - Phone:716-998-5002
Mailing Address - Fax:
Practice Address - Street 1:3050 ORCHARD PARK RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-4658
Practice Address - Country:US
Practice Address - Phone:716-675-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant