Healthcare Provider Details

I. General information

NPI: 1669267209
Provider Name (Legal Business Name): ASPEN FLYNN PA-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MAIN ST
BUFFALO NY
14208-1035
US

IV. Provider business mailing address

40 GRANGER PL
BUFFALO NY
14222-1228
US

V. Phone/Fax

Practice location:
  • Phone: 716-888-2200
  • Fax:
Mailing address:
  • Phone: 559-824-9917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: