Provider Demographics
NPI:1619493780
Name:HABDO, KIERSTEN LEIGH (PA-C)
Entity type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:LEIGH
Last Name:HABDO
Suffix:
Gender:
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 1:45 SPINDRIFT DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7889
Mailing Address - Country:US
Mailing Address - Phone:716-884-3000
Mailing Address - Fax:716-422-5420
Practice Address - Street 1:45 SPINDRIFT DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7889
Practice Address - Country:US
Practice Address - Phone:716-884-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-20
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021204363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical