Provider Demographics
NPI:1831649110
Name:LENTZ, KAYDI (PA-C)
Entity Type:Individual
Prefix:
First Name:KAYDI
Middle Name:
Last Name:LENTZ
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 1:1467 CHESAPEAKE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-4526
Mailing Address - Country:US
Mailing Address - Phone:407-451-1738
Mailing Address - Fax:
Practice Address - Street 1:1955 1ST AVE
Practice Address - Street 2:APT 527
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6408
Practice Address - Country:US
Practice Address - Phone:407-451-1738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020132363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant