National Provider Identifier
Nicole Maria Antzoulides Conroe, P.A.
Nicole Maria Antzoulides Conroe, P.A. is listed in the NPPES registry with a primary specialty of Physician Assistant in Orchard Park, NY and a listed phone number of (716) 662-5357.
Profile Overview
- NPI
- 1740422336
- Provider Type
- Individual
- Primary Specialty
- Physician Assistant
- Enumeration Date
- March 30, 2009
- Last Updated
- February 08, 2021
Practice Location
- 3680 Eggert RD
- Orchard Park, NY 14127-1963
Phone: (716) 662-5357
Specialties
- Physician Assistant (363A00000X)
- Medical Physician Assistant (363AM0700X)
Full Record
- NPI
- 1740422336
- Entity Type
- Individual
- Last Name
- Antzoulides Conroe
- First Name
- Nicole
- Middle Name
- Maria
- Name Prefix
- MS.
- Credential
- P.A.
- Provider Other Last Name
- Antzoulides
- Provider Other First Name
- Nicole
- Provider Other Middle Name
- Maria
- Provider Other Name Prefix Text
- Miss
- Provider Other Last Name Type Code
- 1
- Mailing Street Address
- 3680 Eggert RD
- Mailing City
- Orchard Park
- Mailing State
- NY
- Mailing ZIP Code
- 14127-1963
- Mailing Country
- US
- Practice Street Address
- 3680 Eggert RD
- Practice City
- Orchard Park
- Practice State
- NY
- Practice ZIP Code
- 14127-1963
- Practice Country
- US
- Practice Phone
- (716) 662-5357
- Practice Fax
- (716) 662-2774
- Enumeration Date
- March 30, 2009
- Last Updated
- February 08, 2021
- Sex
- Female
- Sole Proprietor
- No
- Certification Date
- February 08, 2021
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Physician Assistant (363A00000X), Medical Physician Assistant (363AM0700X)
- Other Identifiers
- 013201 (NY, Nys License)