Provider Demographics
NPI:1104868777
Name:MESITI, KARYN MARIE (RPA-C)
Entity type:Individual
Prefix:
First Name:KARYN
Middle Name:MARIE
Last Name:MESITI
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:KARYN
Other - Middle Name:MARIE
Other - Last Name:OETINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:4 LAND RE WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-1741
Mailing Address - Country:US
Mailing Address - Phone:585-368-6620
Mailing Address - Fax:585-368-6621
Practice Address - Street 1:4 LAND RE WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-1741
Practice Address - Country:US
Practice Address - Phone:585-368-6620
Practice Address - Fax:585-368-6621
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007534363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02651403Medicaid
NYJ400371349-GRP70008AMedicare PIN
NY02651403Medicaid
NY019007534OtherEXCELLUS
NY9512378OtherINDEPENDENT HEALTH
NYP34129Medicare UPIN