Healthcare Provider Details

I. General information

NPI: 1326089087
Provider Name (Legal Business Name): SHARON RUTH WITTMAN-KLEIN R.P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 11/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 CAZENOVIA ST
BUFFALO NY
14220-1706
US

IV. Provider business mailing address

18 GRAFTON CT
LANCASTER NY
14086-2361
US

V. Phone/Fax

Practice location:
  • Phone: 716-828-1410
  • Fax: 716-828-1416
Mailing address:
  • Phone: 716-685-9383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number007062
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number007062
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: