Individual
ANITA D O'MALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4103 MEDICAL CENTER DR, FAYETTEVILLE, NY 13066-6600
(315) 637-7800
(315) 637-7808
Mailing address
4103 MEDICAL CENTER DR, FAYETTEVILLE, NY 13066-6600
(315) 637-7800
(315) 637-7808
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
005753
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02405567
—
NY
Enumeration date
03/15/2007
Last updated
04/14/2015
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