Healthcare Provider Details

I. General information

NPI: 1780567974
Provider Name (Legal Business Name): KAYLA DARIENZO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1991 MARCUS AVE STE M100
NEW HYDE PARK NY
11042-2062
US

IV. Provider business mailing address

1116 5TH AVE
EAST NORTHPORT NY
11731-2532
US

V. Phone/Fax

Practice location:
  • Phone: 516-472-3650
  • Fax:
Mailing address:
  • Phone: 631-741-4114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number357282
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: