Provider Demographics
NPI:1982332045
Name:ADRIAN, KAILA MADISON
Entity Type:Individual
Prefix:
First Name:KAILA
Middle Name:MADISON
Last Name:ADRIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3085 SKILLMAN AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-4422
Mailing Address - Country:US
Mailing Address - Phone:516-655-7709
Mailing Address - Fax:
Practice Address - Street 1:2000 N VILLAGE AVE STE 203
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-1001
Practice Address - Country:US
Practice Address - Phone:516-763-1717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant