Healthcare Provider Details

I. General information

NPI: 1164734570
Provider Name (Legal Business Name): AMY KAKKANATT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WOODS RD
VALHALLA NY
10595-1530
US

IV. Provider business mailing address

400 COLUMBUS AVE STE 200E
VALHALLA NY
10595-1392
US

V. Phone/Fax

Practice location:
  • Phone: 914-614-4140
  • Fax:
Mailing address:
  • Phone: 914-614-4229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301097290
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number0101264932
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number343877
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: