Healthcare Provider Details

I. General information

NPI: 1710858972
Provider Name (Legal Business Name): KYANA MCGILL PA-C
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 MIZELL AVE STE 306
WINTER PARK FL
32792-4155
US

IV. Provider business mailing address

1925 MIZELL AVE STE 306
WINTER PARK FL
32792-4155
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-1380
  • Fax:
Mailing address:
  • Phone: 407-303-1380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9120769
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9120769
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9120769
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: