Provider Demographics
NPI:1801202072
Name:GERMANO, KAYLA P (PA-C)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:P
Last Name:GERMANO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:GERMANO
Other - Last Name:POTTBECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:622 BANTAM RD
Mailing Address - Street 2:
Mailing Address - City:BANTAM
Mailing Address - State:CT
Mailing Address - Zip Code:06750-1600
Mailing Address - Country:US
Mailing Address - Phone:860-361-6650
Mailing Address - Fax:860-361-6654
Practice Address - Street 1:622 BANTAM RD
Practice Address - Street 2:
Practice Address - City:BANTAM
Practice Address - State:CT
Practice Address - Zip Code:06750-1600
Practice Address - Country:US
Practice Address - Phone:860-361-6650
Practice Address - Fax:860-361-6654
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3104363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant