Provider Demographics
NPI:1265082101
Name:PANTALONE, KAYLA MARIE (PA)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:PANTALONE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:261 ROBERT MORRIS BLVD APT 413
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4571
Mailing Address - Country:US
Mailing Address - Phone:941-735-4109
Mailing Address - Fax:
Practice Address - Street 1:1600 HADDON AVE FL 6
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-3101
Practice Address - Country:US
Practice Address - Phone:856-757-3500
Practice Address - Fax:856-365-4088
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
NJ25MP00587100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant