Provider Demographics
NPI:1053850438
Name:JULIANO, ZACHARY (PA)
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:
Last Name:JULIANO
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 1:55 SPINDRIFT DR STE 120
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7800
Mailing Address - Country:US
Mailing Address - Phone:716-539-4772
Mailing Address - Fax:
Practice Address - Street 1:55 SPINDRIFT DR STE 120
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7800
Practice Address - Country:US
Practice Address - Phone:716-539-4772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020632363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY16-1566929OtherEMPLOYER ID NUMBER (EIN)