Healthcare Provider Details

I. General information

NPI: 1174472914
Provider Name (Legal Business Name): KAYLA MARIE EMMANUEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2026
Last Update Date: 01/26/2026
Certification Date: 01/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N STATE ST
DOVER DE
19901-3835
US

IV. Provider business mailing address

120 N STATE ST
DOVER DE
19901-3835
US

V. Phone/Fax

Practice location:
  • Phone: 917-770-3979
  • Fax:
Mailing address:
  • Phone: 917-770-3979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2375470
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: