Provider Demographics
NPI:1407850886
Name:SCHIELE, KATHLEEN E (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:E
Last Name:SCHIELE
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4855 CAMP RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-2600
Mailing Address - Country:US
Mailing Address - Phone:716-646-1084
Mailing Address - Fax:716-646-0763
Practice Address - Street 1:4855 CAMP RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-2600
Practice Address - Country:US
Practice Address - Phone:716-646-1084
Practice Address - Fax:716-646-0763
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002368-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02933833Medicaid
00026556202OtherUNIVERA
NY141534BFOtherPREFERRED CARE
NY9511805OtherINDEPENDENT HEALTH
NY000570020004OtherBC/BS
NY01275947Medicaid
NYP00625904Medicare PIN
NY000570020004OtherBC/BS
NY02933833Medicaid
NY01275947Medicaid
NYAA0500Medicare ID - Type Unspecified