Healthcare Provider Details

I. General information

NPI: 1326951039
Provider Name (Legal Business Name): KATELYN GONYO
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 ROUTE 276
CHAMPLAIN NY
12919
US

IV. Provider business mailing address

103 ROUTE 276
CHAMPLAIN NY
12919
US

V. Phone/Fax

Practice location:
  • Phone: 518-298-8242
  • Fax: 518-957-4153
Mailing address:
  • Phone: 518-298-8242
  • Fax: 518-957-4153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number849124
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: