Healthcare Provider Details

I. General information

NPI: 1629322060
Provider Name (Legal Business Name): ERICA LYNN DUTTER TRIMM PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4115 MEDICAL CENTER DR STE 115
FAYETTEVILLE NY
13066-6636
US

IV. Provider business mailing address

4592 MYSTIC DR
JAMESVILLE NY
13078-6522
US

V. Phone/Fax

Practice location:
  • Phone: 315-329-2555
  • Fax: 315-744-1957
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number020198
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number002370
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number020198
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: