Individual
ASHLEY L WYANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1021 BROADWAY ST, BUFFALO, NY 14212-1460
(716) 529-2030
Mailing address
184 BARTON ST, BUFFALO, NY 14213-1573
(716) 881-6191
(716) 881-6247
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
021113-1
NY
363A00000X
Physician Assistant
Primary
021113
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05022115
—
NY
Enumeration date
09/15/2015
Last updated
11/06/2019
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