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Individual

BETH A GILLEZEAU

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
8750 TRANSIT RD, SUITE 105, EAST AMHERST, NY 14051-2610
(716) 636-1470
(716) 636-1423
Mailing address
8750 TRANSIT RD, SUITE 105, EAST AMHERST, NY 14051-2610
(716) 636-1470
(716) 636-1423

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
011994
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
011994
LICENSE
NY
Enumeration date
08/09/2007
Last updated
08/10/2012
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