Healthcare Provider Details

I. General information

NPI: 1053107177
Provider Name (Legal Business Name): KAITLYN HYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 ELLICOTT ST
BUFFALO NY
14203-1021
US

IV. Provider business mailing address

818 ELLICOTT ST
BUFFALO NY
14203-1021
US

V. Phone/Fax

Practice location:
  • Phone: 716-323-2000
  • Fax:
Mailing address:
  • Phone: 716-323-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number036894-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: