Provider Demographics
NPI:1629594494
Name:KAVO, EMMA (PA-C)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:KAVO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6122G FRESH POND RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-1040
Mailing Address - Country:US
Mailing Address - Phone:718-502-3000
Mailing Address - Fax:
Practice Address - Street 1:6122G FRESH POND RD
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-1040
Practice Address - Country:US
Practice Address - Phone:718-502-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant