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General NPI Number Information
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NPI Number | 1538482518
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Entity Type | Individual
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Provider Name | KELLY PASIECZNIK
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Gender | Female
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Dates
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Enumeration Date | 03/05/2010
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Last Update Date | 10/08/2012
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Provider Practice Location Address
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Address Line | 325 ESSJAY RD
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-8243
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Country | US
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Telephone | 716-630-1102
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Fax | 716-633-6507
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Provider Business Mailing Address
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Address Line | 6255 SHERIDAN DR SUITE 304
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-4836
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Country | US
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Telephone | 716-857-8666
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Fax | 716-630-1054
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 013964
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License Number State | NY
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