Provider Demographics
NPI:1447780127
Name:REINHARDT, KELLI (PA)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:REINHARDT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 INTERNATIONAL DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5771
Mailing Address - Country:US
Mailing Address - Phone:716-631-3555
Mailing Address - Fax:
Practice Address - Street 1:400 INTERNATIONAL DR STE 2
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5771
Practice Address - Country:US
Practice Address - Phone:716-631-3555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical