Healthcare Provider Details

I. General information

NPI: 1528681947
Provider Name (Legal Business Name): KYLIE NIKOLE JUNGLES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 SOUTHWOODS BLVD
ALBANY NY
12211-2554
US

IV. Provider business mailing address

8 SOUTHWOODS BLVD
ALBANY NY
12211-2554
US

V. Phone/Fax

Practice location:
  • Phone: 518-434-1446
  • Fax: 518-434-0806
Mailing address:
  • Phone: 518-434-1446
  • Fax: 518-434-0806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number036.165313
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number336450-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: