Roy M Sleboda, RPA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

003940 Issued in NY

Practice address

95 E Chautauqua St.
Mayville, NY 14757-0168

Phone

(716) 753-7107

Fax

(716) 753-7980

NPI assigned

Mar 15, 2006

Last updated

Feb 29, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330473600000",
    "number": "1972572691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 E CHAUTAUQUA ST",
            "address_2": "PO BOX 168",
            "city": "MAYVILLE",
            "state": "NY",
            "postal_code": "147570168",
            "telephone_number": "716-753-7107",
            "fax_number": "716-753-7980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 E CHAUTAUQUA ST.",
            "city": "MAYVILLE",
            "state": "NY",
            "postal_code": "147570168",
            "telephone_number": "716-753-7107",
            "fax_number": "716-753-7980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SLEBODA",
        "first_name": "ROY",
        "middle_name": "M",
        "credential": "RPA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-15",
        "last_updated": "2012-02-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "003940",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSWNY",
            "identifier": "000570065003",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA",
            "identifier": "00026498502",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01594765",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENT HEALTH",
            "identifier": "9512028",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary H. Richardson, RN
• Jeremy Martin Riedesel, MD
• Robert Berke MD (Family Health Services)
• Amy Rosenberg-Snyder
• Alexander Z Selioutski, M.D.
• Scott Swanson, PT
• Therapy Connection, LLC
• Karen A Thomas, LPN
• Connie Jo Tonger, NP
• Sarah Ann Uebelhoer, PA-C

• Physician Assistant in Mayville, NY
• Providers in Mayville, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.