Provider Demographics
NPI:1003211087
Name:CALABRO, KAYLA (LAC)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:CALABRO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 WILLIAM FLOYD PKWY
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-3420
Mailing Address - Country:US
Mailing Address - Phone:631-332-7805
Mailing Address - Fax:
Practice Address - Street 1:320 MERRICK RD
Practice Address - Street 2:#3
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-3440
Practice Address - Country:US
Practice Address - Phone:631-691-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005418171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist