Healthcare Provider Details

I. General information

NPI: 1386032928
Provider Name (Legal Business Name): KARYANNE CARRIZALES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2015
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E TUPPER ST
BUFFALO NY
14203-1315
US

IV. Provider business mailing address

100 E TUPPER ST
BUFFALO NY
14203-1315
US

V. Phone/Fax

Practice location:
  • Phone: 716-919-6870
  • Fax: 716-919-6871
Mailing address:
  • Phone: 716-919-6870
  • Fax: 716-919-6871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number018191-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: