Healthcare Provider Details

I. General information

NPI: 1316577232
Provider Name (Legal Business Name): KAYLA BUZZETTA-KAST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2020
Last Update Date: 01/20/2020
Certification Date: 01/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1128 BEVILLE RD STE A
DAYTONA BEACH FL
32114-5769
US

IV. Provider business mailing address

300 INTERNATIONAL PARKWAY SUITE 200
LAKE MARY FL
32746-3625
US

V. Phone/Fax

Practice location:
  • Phone: 386-267-3161
  • Fax:
Mailing address:
  • Phone: 866-610-0580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: