Individual
ELISSA BAUTISTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2001 MAIN ST, BUFFALO, NY 14208-1035
(716) 883-7000
Mailing address
4 MAPLE AVE, LYNBROOK, NY 11563-2531
(516) 946-0632
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
034898
NY
Other
Enumeration date
11/04/2025
Last updated
11/04/2025
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