Provider Demographics
NPI:1881161198
Name:TYTKA, KAITLYN A (PA)
Entity type:Individual
Prefix:MISS
First Name:KAITLYN
Middle Name:A
Last Name:TYTKA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:45 SPINDRIFT DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7889
Mailing Address - Country:US
Mailing Address - Phone:716-422-5422
Mailing Address - Fax:716-422-5420
Practice Address - Street 1:45 SPINDRIFT DR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14221-7889
Practice Address - Country:US
Practice Address - Phone:716-422-5422
Practice Address - Fax:716-422-5420
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY025494363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical