Provider Demographics
NPI:1679461636
Name:HLYWA, CARRISSA (PA-C)
Entity type:Individual
Prefix:
First Name:CARRISSA
Middle Name:
Last Name:HLYWA
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 1:40 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-4936
Mailing Address - Country:US
Mailing Address - Phone:315-246-4558
Mailing Address - Fax:
Practice Address - Street 1:40 LAKE AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-4936
Practice Address - Country:US
Practice Address - Phone:315-246-4558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant