Provider Demographics
NPI:1376115162
Name:HOEFLICH, MICHAELA ROSE (PA)
Entity type:Individual
Prefix:MISS
First Name:MICHAELA
Middle Name:ROSE
Last Name:HOEFLICH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:32 POND BROOK DR
Mailing Address - Street 2:
Mailing Address - City:ELMA
Mailing Address - State:NY
Mailing Address - Zip Code:14059-9403
Mailing Address - Country:US
Mailing Address - Phone:716-829-9689
Mailing Address - Fax:
Practice Address - Street 1:501 KENMORE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14223-2864
Practice Address - Country:US
Practice Address - Phone:716-768-4636
Practice Address - Fax:716-768-4656
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY026774363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical