Provider Demographics
NPI:1184722415
Name:WYDYSH, DEBORAH A (ANP-C)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:WYDYSH
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1783 COLVIN BLVD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14223-1107
Mailing Address - Country:US
Mailing Address - Phone:716-693-2423
Mailing Address - Fax:
Practice Address - Street 1:1783 COLVIN BLVD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14223-1107
Practice Address - Country:US
Practice Address - Phone:716-874-2150
Practice Address - Fax:716-874-6765
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300587363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health