Basic Information
| Provider Information | |||||||||
| NPI: | 1255560942 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SZYMANSKI | ||||||||
| FirstName: | TALIA | ||||||||
| MiddleName: | GRACE | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5500 MAIN ST 107 | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142216766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7169065908 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3671 SOUTHWESTERN BLVD | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | ORCHARD PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141271752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168214400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2009 | ||||||||
| LastUpdateDate: | 07/13/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 013303 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.