Provider Demographics
NPI:1447429881
Name:MINOR, BRANDY LEIGH (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:LEIGH
Last Name:MINOR
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Gender:F
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:235 NORTH ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201-1435
Mailing Address - Country:US
Mailing Address - Phone:716-882-0726
Mailing Address - Fax:716-882-3484
Practice Address - Street 1:235 NORTH ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-1435
Practice Address - Country:US
Practice Address - Phone:716-882-0726
Practice Address - Fax:716-882-3484
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2014-03-04
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Provider Licenses
StateLicense IDTaxonomies
NY012404-1363A00000X
SC1319363A00000X
FLPA9106118363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical