| Doctor Name: | KELLY PIETRZAK |
| NPI Number: | 1063572378 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APN |
| License Number: | F30394 |
| Business Practice Address: | 3091 William Street Cheektowaga, NY - 142271919 |
| Business Phone Number: | 7168352981 |
| Business Fax Number: | |
| Mailing Address: | 3435 Bailey Ave, BUFFALO |
| State: | NY |
| Postal Code: | 142151145 |
| Phone Number: | 7168352966 |
| Fax Number: | 7168343901 |
| NPI Enumeration Date: | 12/11/2006 |
| NPI Last Update Date: | 04/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | F30394 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |