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NPI Code Detail

MEDICARE: KAYLEE WIECHELT

MEDICARE: KAYLEE WIECHELT
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
1363A00000XPhysician Assistant021617-1NY

General Provider Information

NPI Number : 1720591332
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAYLEE WIECHELT
Provider Business Mailing Address
First Line : ELM AND CARLTON ST
Second Line :
City : BUFFALO
State : NY
Zip : 14263-0001
Country : US
Telephone Number : 716-845-2300
Fax Number :
Provider Business Practice Location Address
First Line : 2609 THREE ROD RD
Second Line :
City : EAST AURORA
State : NY
Zip : 14052-9571
Country : US
Telephone Number : 716-864-2556
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2017
Last Update Date : 12/05/2025

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Directions to “ KAYLEE WIECHELT ” Practice Location

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