Provider Demographics
NPI:1750191227
Name:HENDERSON, ALTHEA ROSE (PA)
Entity type:Individual
Prefix:
First Name:ALTHEA
Middle Name:ROSE
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2221 COUNTY ROUTE 45
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-4479
Mailing Address - Country:US
Mailing Address - Phone:315-529-0115
Mailing Address - Fax:
Practice Address - Street 1:7851 BREWERTON RD # 1
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-9533
Practice Address - Country:US
Practice Address - Phone:315-484-5809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant