Healthcare Provider Details

I. General information

NPI: 1639601917
Provider Name (Legal Business Name): KAYLA ROSE BRACEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLA ROSE GLATMAN

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3732 CARMAN RD
SCHENECTADY NY
12303-5422
US

IV. Provider business mailing address

711 TROY SCHENECTADY RD STE 203
LATHAM NY
12110-2461
US

V. Phone/Fax

Practice location:
  • Phone: 518-356-4132
  • Fax: 518-355-3996
Mailing address:
  • Phone: 518-782-3700
  • Fax: 518-782-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number305104
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: