Healthcare Provider Details

I. General information

NPI: 1548193410
Provider Name (Legal Business Name): LARA KAY SIAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 MAIN ST STE 103
SPRINGFIELD MA
01107-1139
US

IV. Provider business mailing address

32 SHADOW BROOK EST
SOUTH HADLEY MA
01075-2676
US

V. Phone/Fax

Practice location:
  • Phone: 413-785-5321
  • Fax:
Mailing address:
  • Phone: 401-580-1023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: