Healthcare Provider Details

I. General information

NPI: 1841716909
Provider Name (Legal Business Name): TARA KAY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2017
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 S STATE ST STE 100
DOVER DE
19901-4112
US

IV. Provider business mailing address

39 DEBORAH DR
DOVER DE
19901-6403
US

V. Phone/Fax

Practice location:
  • Phone: 302-734-7676
  • Fax: 302-734-7615
Mailing address:
  • Phone: 302-382-7835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110-005823
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0001220
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: