Provider Demographics
NPI:1104124858
Name:AGRAFIOTIS, KATELYNN T (PA-C)
Entity type:Individual
Prefix:
First Name:KATELYNN
Middle Name:T
Last Name:AGRAFIOTIS
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 1:35 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BELCHERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01007-8909
Mailing Address - Country:US
Mailing Address - Phone:413-213-0550
Mailing Address - Fax:413-213-0554
Practice Address - Street 1:35 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:BELCHERTOWN
Practice Address - State:MA
Practice Address - Zip Code:01007-8909
Practice Address - Country:US
Practice Address - Phone:413-213-0550
Practice Address - Fax:413-213-0554
Is Sole Proprietor?:No
Enumeration Date:2011-03-04
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4139363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant