Provider Demographics
NPI:1023044450
Name:DUDRAK, KIMBERLY AMATRUDA (PA C)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:AMATRUDA
Last Name:DUDRAK
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3889 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454
Mailing Address - Country:US
Mailing Address - Phone:585-243-4000
Mailing Address - Fax:585-243-4002
Practice Address - Street 1:36 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14437-1632
Practice Address - Country:US
Practice Address - Phone:585-335-2030
Practice Address - Fax:585-335-2035
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6096363AM0700X
NY006096363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P019006096OtherBC
109052DLOtherPFC
02286753OtherMED
02286753OtherMED