Healthcare Provider Details

I. General information

NPI: 1861291924
Provider Name (Legal Business Name): NIKITA RAYBUCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NIKITA AHUJA PA-C

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 WASHINGTON RD STE 203
MC MURRAY PA
15317-3279
US

IV. Provider business mailing address

3055 WASHINGTON RD STE 203
MC MURRAY PA
15317-3279
US

V. Phone/Fax

Practice location:
  • Phone: 724-260-5424
  • Fax:
Mailing address:
  • Phone: 724-260-5424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA066389
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0012282
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: