Healthcare Provider Details

I. General information

NPI: 1760143291
Provider Name (Legal Business Name): KAYLA MCMANUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 1ST ST
GLENWOOD LANDING NY
11547-3001
US

IV. Provider business mailing address

10 1ST ST
GLENWOOD LANDING NY
11547-3001
US

V. Phone/Fax

Practice location:
  • Phone: 516-532-4474
  • Fax:
Mailing address:
  • Phone: 516-532-4474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279E1000X
TaxonomyEducational Registered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: