Healthcare Provider Details

I. General information

NPI: 1770466286
Provider Name (Legal Business Name): KYLEIGH STORRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4057 WEST RD
CORTLAND NY
13045-1637
US

IV. Provider business mailing address

1 GUTHRIE SQ
SAYRE PA
18840-1625
US

V. Phone/Fax

Practice location:
  • Phone: 607-753-9977
  • Fax: 570-887-6864
Mailing address:
  • Phone: 607-753-9977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number035859
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: