Provider Demographics
NPI:1326089087
Name:WITTMAN-KLEIN, SHARON RUTH (RPA-C)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:RUTH
Last Name:WITTMAN-KLEIN
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 GRAFTON CT
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-2361
Mailing Address - Country:US
Mailing Address - Phone:716-685-9383
Mailing Address - Fax:
Practice Address - Street 1:22 CAZENOVIA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220-1706
Practice Address - Country:US
Practice Address - Phone:716-828-1410
Practice Address - Fax:716-828-1416
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007062363AS0400X
007062363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000570313003OtherBLUE CROSS OF WESTERN NY
NY00026504601OtherUNIVERA
NY9512094OtherINDEPENDENT HEALTH ASSOCI
NY02166512Medicaid
NYJ400028047Medicare PIN
NY9512094OtherINDEPENDENT HEALTH ASSOCI