Individual
AMANDA N WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3884 BROADWAY ST, CHEEKTOWAGA, NY 14227-1111
(716) 681-9000
Mailing address
3884 BROADWAY ST, CHEEKTOWAGA, NY 14227-1111
(716) 681-9000
(716) 256-1079
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
018561
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8204874
MVP
NY
01
—
8391586
CIGNA
NY
Enumeration date
11/24/2015
Last updated
05/02/2021
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