Provider Demographics
NPI:1851469191
Name:KUBIAK, AMY LYNN (FNP-BC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:KUBIAK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:BAUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:299 LEYDECKER RD APT B4
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-4561
Mailing Address - Country:US
Mailing Address - Phone:716-984-3595
Mailing Address - Fax:
Practice Address - Street 1:299 LEYDECKER RD APT B4
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-4561
Practice Address - Country:US
Practice Address - Phone:716-984-3595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334925363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000528956001OtherBCBS
NY9514090OtherINDEPENDENT HEALTH
NY00027812801OtherUNIVERA
NY02845792Medicaid