MEDICARE: DR. KHRYSTYNA SOBKO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		NY

General Provider Information

NPI Number	:	1619822988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KHRYSTYNA SOBKO DDS

Provider Business Mailing Address
First Line	:	12 CLOVERSIDE DR
Second Line	:
City	:	LANCASTER
State	:	NY
Zip	:	14086-2908
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3495 BAILEY AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14215-1129
Country	:	US
Telephone Number	:	716-834-9200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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