Individual
TERESA A MICCA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
ELM AND CARLTON ST, BUFFALO, NY 14263-0001
(716) 845-2300
Mailing address
100 KINGS HWY S, ROCHESTER, NY 14617-5504
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
024430
NY
363AM0700X
Medical Physician Assistant
Primary
024430
NY
Other
Enumeration date
10/17/2019
Last updated
02/02/2026
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