Healthcare Provider Details

I. General information

NPI: 1205749959
Provider Name (Legal Business Name): KIERSTEN PRZYBYLSKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

297 SPINDRIFT DR STE 100
WILLIAMSVILLE NY
14221-7894
US

IV. Provider business mailing address

11026 TINKHAM RD
DARIEN CENTER NY
14040-9624
US

V. Phone/Fax

Practice location:
  • Phone: 716-831-2600
  • Fax:
Mailing address:
  • Phone: 585-483-1714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number03612201
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: