Healthcare Provider Details

I. General information

NPI: 1720526114
Provider Name (Legal Business Name): KAYLA SESTO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLA DEVORE

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW
WASHINGTON DC
20010-3017
US

IV. Provider business mailing address

1331 4TH ST SE APT 510
WASHINGTON DC
20003-4459
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-2391
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: