Provider Demographics
NPI:1386313047
Name:BREEN, KATLYN ELIZABETH (PA)
Entity type:Individual
Prefix:
First Name:KATLYN
Middle Name:ELIZABETH
Last Name:BREEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KATLYN
Other - Middle Name:ELIZABETH
Other - Last Name:BROMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:138 DAVIS AVE
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12188-2122
Mailing Address - Country:US
Mailing Address - Phone:443-224-0701
Mailing Address - Fax:
Practice Address - Street 1:43 NEW SCOTLAND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3478
Practice Address - Country:US
Practice Address - Phone:518-262-3125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027190363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant