Healthcare Provider Details

I. General information

NPI: 1386506889
Provider Name (Legal Business Name): KAITLIN KARAKAEDOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 COLWELL LN
CONSHOHOCKEN PA
19428-1111
US

IV. Provider business mailing address

636 ROXBOROUGH AVE
PHILADELPHIA PA
19128-1709
US

V. Phone/Fax

Practice location:
  • Phone: 267-217-3712
  • Fax:
Mailing address:
  • Phone: 484-883-7484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-303906
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: