Individual
MRS. BRENDA LEAIRD KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3900 N BUFFALO ST, ORCHARD PARK, NY 14127-1842
(716) 656-4816
(716) 817-1766
Mailing address
425 ESSJAY RD STE 170, WILLIAMSVILLE, NY 14221-8235
(716) 630-1219
(716) 817-1726
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
005508
NY
363AS0400X
Surgical Physician Assistant
005508
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000570209005
BCBS OF WNY
NY
01
—
040909000003
FIDELIS CARE
NY
01
—
11563513
CAQH
NY
01
—
180049FL
PREFERRED CARE
NY
01
—
9513175
IHA
NY
01
—
P00338492
MEDICARE RAILROAD
NY
Enumeration date
07/12/2006
Last updated
12/20/2021
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