Provider Demographics
NPI:1164931101
Name:CIANCIOTTI, KARA MICHELLE (PA)
Entity Type:Individual
Prefix:MRS
First Name:KARA
Middle Name:MICHELLE
Last Name:CIANCIOTTI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:KARA
Other - Middle Name:MICHELLE
Other - Last Name:KURTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:370 SMITH AVE
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-4700
Mailing Address - Country:US
Mailing Address - Phone:631-742-6923
Mailing Address - Fax:
Practice Address - Street 1:373 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-5901
Practice Address - Country:US
Practice Address - Phone:631-422-3377
Practice Address - Fax:631-422-3382
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021029-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant