Basic Information
Provider Information
NPI: 1255049052
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GAY
FirstName: ALLYSON
MiddleName: EMILY
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8600 NOTTINGHAM TER
Address2:  
City: WILLIAMSVILLE
State: NY
PostalCode: 142217417
CountryCode: US
TelephoneNumber: 7169971975
FaxNumber:  
Practice Location
Address1: 5904 SHERIDAN DR
Address2:  
City: WILLIAMSVILLE
State: NY
PostalCode: 142215873
CountryCode: US
TelephoneNumber: 7168865493
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/10/2022
LastUpdateDate: 11/10/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/10/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0808XF404589-01NYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsych/Mental Health

No ID Information.


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