Provider Demographics
NPI:1801885074
Name:DYER, PATRICIA L (NP)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:L
Last Name:DYER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 E DELAVAN AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-3946
Mailing Address - Country:US
Mailing Address - Phone:716-308-6302
Mailing Address - Fax:617-608-0485
Practice Address - Street 1:1520 E DELAVAN AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3946
Practice Address - Country:US
Practice Address - Phone:716-308-6302
Practice Address - Fax:617-608-0485
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381522363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02357633Medicaid