Provider Demographics
NPI:1639797186
Name:CIRILLO, KATHYRN ROYS
Entity type:Individual
Prefix:
First Name:KATHYRN
Middle Name:ROYS
Last Name:CIRILLO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:MICHELLE
Other - Last Name:ROYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4309 EMPEROR BLVD STE 125
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-8068
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4309 EMPEROR BLVD STE 125
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-8068
Practice Address - Country:US
Practice Address - Phone:919-941-0158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-10
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-10760363AM0700X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant