Healthcare Provider Details

I. General information

NPI: 1831854900
Provider Name (Legal Business Name): MARY ZITTEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 MAIN ST
EAST AURORA NY
14052-1717
US

IV. Provider business mailing address

1271 SWEET RD
EAST AURORA NY
14052-3012
US

V. Phone/Fax

Practice location:
  • Phone: 716-652-5499
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number028380
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: