Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 021113-1 | NY |
NPI | 1003285552 |
---|---|
Provider Name | Ashley L Wyant |
First Address | Buffalo, NY 14213-1573 |
Second Address | Buffalo, NY 14212-1460 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2015 |
Last Update Date | 06/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05022115 | (05) | NY |