MEDICARE: KAYLEIGH SURENDRA 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	0010-04330	NC

General Provider Information

NPI Number	:	1851643670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLEIGH SURENDRA PA-C

Provider Business Mailing Address
First Line	:	200 OLIVE FIELD DR
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-6215
Country	:	US
Telephone Number	:	443-315-3785
Fax Number	:

Provider Business Practice Location Address
First Line	:	126 GRAND HILL PL
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-4416
Country	:	US
Telephone Number	:	919-285-2138
Fax Number	:

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

Provider Enumeration Date	:	10/03/2012
Last Update Date	:	10/20/2025

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