Provider Demographics
NPI:1487251534
Name:GRIFFIN, AMY JEAN (PA-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JEAN
Last Name:GRIFFIN
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 1:17 DEER PATH
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-4544
Mailing Address - Country:US
Mailing Address - Phone:716-771-9050
Mailing Address - Fax:
Practice Address - Street 1:17 DEER PATH
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-4544
Practice Address - Country:US
Practice Address - Phone:716-771-9050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025722363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant