MEDICARE: MRS. LARA SHANI KAIN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0110001645	VA

General Provider Information

NPI Number	:	1760580534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LARA SHANI KAIN PA-C

Provider Business Mailing Address
First Line	:	9629 SELBY PL
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23503-1717
Country	:	US
Telephone Number	:	757-639-6858
Fax Number	:	757-547-4584

Provider Business Practice Location Address
First Line	:	117 W 21ST ST STE 205
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23517-2246
Country	:	US
Telephone Number	:	757-603-4604
Fax Number	:	757-210-4360

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	03/19/2022

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