Healthcare Provider Details

I. General information

NPI: 1639093545
Provider Name (Legal Business Name): KAITLYN DEVINE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 W GARDEN ST STE 203
AUBURN NY
13021-2657
US

IV. Provider business mailing address

3027 BRICKWALK WAY
BALDWINSVILLE NY
13027-6130
US

V. Phone/Fax

Practice location:
  • Phone: 315-567-0507
  • Fax:
Mailing address:
  • Phone: 315-726-2524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number036257
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: