Provider Demographics
NPI:1255574026
Name:AZZARA, KAY (RPA-C)
Entity type:Individual
Prefix:
First Name:KAY
Middle Name:
Last Name:AZZARA
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2905
Mailing Address - Country:US
Mailing Address - Phone:631-979-0909
Mailing Address - Fax:631-979-0455
Practice Address - Street 1:327 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787
Practice Address - Country:US
Practice Address - Phone:631-979-0909
Practice Address - Fax:631-979-0455
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013088-1363A00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207N00000XAllopathic & Osteopathic PhysiciansDermatology