Provider Demographics
NPI:1003653619
Name:MAYO, KAYLAN MICHELLE (PA-C)
Entity type:Individual
Prefix:MS
First Name:KAYLAN
Middle Name:MICHELLE
Last Name:MAYO
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:34 BENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1761
Mailing Address - Country:US
Mailing Address - Phone:716-986-9199
Mailing Address - Fax:716-342-2340
Practice Address - Street 1:34 BENWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1761
Practice Address - Country:US
Practice Address - Phone:716-986-9199
Practice Address - Fax:716-342-2340
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY032358OtherNY LICENSE