Provider Demographics
NPI:1174146435
Name:ANDREWS, KYLE
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4957 N BYRON RD
Mailing Address - Street 2:
Mailing Address - City:ELBA
Mailing Address - State:NY
Mailing Address - Zip Code:14058-9705
Mailing Address - Country:US
Mailing Address - Phone:585-409-9170
Mailing Address - Fax:
Practice Address - Street 1:322 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14608-1162
Practice Address - Country:US
Practice Address - Phone:585-254-6480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant