Provider Demographics
NPI:1447886700
Name:BETANCES, RAYNALDO (PA)
Entity type:Individual
Prefix:
First Name:RAYNALDO
Middle Name:
Last Name:BETANCES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 NIAGARA ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201-2135
Mailing Address - Country:US
Mailing Address - Phone:716-242-8600
Mailing Address - Fax:716-332-0917
Practice Address - Street 1:300 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-2135
Practice Address - Country:US
Practice Address - Phone:716-242-8600
Practice Address - Fax:716-332-0917
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024853363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant