Provider Demographics
NPI:1255334363
Name:DYBUS, KAREN RENATE (RPA)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:RENATE
Last Name:DYBUS
Suffix:
Gender:F
Credentials:RPA
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Mailing Address - Street 1:10 TODD CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4224
Mailing Address - Country:US
Mailing Address - Phone:631-470-3243
Mailing Address - Fax:
Practice Address - Street 1:STUDENT HEALTH SERVICE
Practice Address - Street 2:STADIUM ROAD
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-3191
Practice Address - Country:US
Practice Address - Phone:631-632-6739
Practice Address - Fax:631-632-6936
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY4005-01363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant