Provider Demographics
NPI:1639601917
Name:BRACEY, KAYLA ROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:ROSE
Last Name:BRACEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:ROSE
Other - Last Name:GLATMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:3732 CARMAN RD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-5422
Practice Address - Country:US
Practice Address - Phone:518-356-4132
Practice Address - Fax:518-355-3996
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY305104208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program