Provider Demographics
NPI:1437984135
Name:WESOLOWSKI, KAITLYN PAIGE (PA-C)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:PAIGE
Last Name:WESOLOWSKI
Suffix:
Gender:F
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 1:33 SPRING CREEK DR APT 403
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-5737
Mailing Address - Country:US
Mailing Address - Phone:845-532-0787
Mailing Address - Fax:
Practice Address - Street 1:404 ZENA RD STE 1
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:NY
Practice Address - Zip Code:12498-2627
Practice Address - Country:US
Practice Address - Phone:845-679-5271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03250301363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant