Provider Demographics
NPI:1184150567
Name:CORREIA-STAUDT, KAYLA LEONARD
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:LEONARD
Last Name:CORREIA-STAUDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:LEONARD
Other - Last Name:CORREIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:959 PANORAMA TRL S STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2311
Mailing Address - Country:US
Mailing Address - Phone:585-276-9361
Mailing Address - Fax:585-248-3703
Practice Address - Street 1:959 PANORAMA TRL S STE 100
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2311
Practice Address - Country:US
Practice Address - Phone:585-276-9361
Practice Address - Fax:585-248-3703
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304407207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine