Provider Demographics
NPI:1588450373
Name:FUNDERBURK, HALEY JOANNE (PA-C)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:JOANNE
Last Name:FUNDERBURK
Suffix:
Gender:
Credentials:PA-C
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2890 NIAGARA FALLS BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-1114
Mailing Address - Country:US
Mailing Address - Phone:716-807-7337
Mailing Address - Fax:716-213-4400
Practice Address - Street 1:605 GROVER CLEVELAND HWY
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-2925
Practice Address - Country:US
Practice Address - Phone:716-836-3300
Practice Address - Fax:716-836-4640
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY033648363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant