Healthcare Provider Details

I. General information

NPI: 1033033709
Provider Name (Legal Business Name): KAYLA MANCUSI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

90 S BEDFORD RD
MOUNT KISCO NY
10549-3412
US

IV. Provider business mailing address

90 S BEDFORD RD
MOUNT KISCO NY
10549-3412
US

V. Phone/Fax

Practice location:
  • Phone: 914-242-1380
  • Fax:
Mailing address:
  • Phone: 914-242-1380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number804667
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: