Provider Demographics
NPI:1962468413
Name:PALAZZO, ROSE THERESA (PA)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:THERESA
Last Name:PALAZZO
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 1:3834 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1039
Mailing Address - Country:US
Mailing Address - Phone:716-877-1221
Mailing Address - Fax:716-218-2721
Practice Address - Street 1:3834 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1039
Practice Address - Country:US
Practice Address - Phone:716-877-1221
Practice Address - Fax:716-218-2721
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004223363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR0B911Medicare UPIN