Provider Demographics
NPI:1477998599
Name:PANDYA, KAYLESH K (DO)
Entity type:Individual
Prefix:DR
First Name:KAYLESH
Middle Name:K
Last Name:PANDYA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 W RAILROAD AVE # 234
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-3522
Mailing Address - Country:US
Mailing Address - Phone:360-529-1234
Mailing Address - Fax:360-284-2535
Practice Address - Street 1:625 W RAILROAD AVE # 234
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-3522
Practice Address - Country:US
Practice Address - Phone:360-529-1234
Practice Address - Fax:360-284-2535
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14868204D00000X, 207Q00000X
WAOP61475133207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAOP61475133OtherWASHINGTON OSTEOPATHIC PHYSICIAN LICENSE