Healthcare Provider Details

I. General information

NPI: 1770412330
Provider Name (Legal Business Name): KAYLA REESE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2579 OCEAN AVE FL 3
BROOKLYN NY
11229-4552
US

IV. Provider business mailing address

279 OLD FARMINGDALE RD
WEST BABYLON NY
11704-6423
US

V. Phone/Fax

Practice location:
  • Phone: 646-780-0926
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: