Healthcare Provider Details

I. General information

NPI: 1699688226
Provider Name (Legal Business Name): KELLY HUYNH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST
SYRACUSE NY
13210-2306
US

IV. Provider business mailing address

550 E GENESEE ST
SYRACUSE NY
13202-2158
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-5540
  • Fax:
Mailing address:
  • Phone: 315-464-5540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number035582
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: