Provider Demographics
NPI:1447547310
Name:ABRAM, MANDY LYNN (RPA-C)
Entity type:Individual
Prefix:MS
First Name:MANDY
Middle Name:LYNN
Last Name:ABRAM
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:LYNN
Other - Last Name:HORNBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:1150 YOUNGS RD
Mailing Address - Street 2:SUITE104
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-8053
Mailing Address - Country:US
Mailing Address - Phone:716-636-7979
Mailing Address - Fax:716-636-7993
Practice Address - Street 1:1150 YOUNGS RD
Practice Address - Street 2:SUITE104
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-8053
Practice Address - Country:US
Practice Address - Phone:716-636-7979
Practice Address - Fax:716-636-7993
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014845363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03356952Medicaid
NYJ400056338Medicare PIN