Healthcare Provider Details

I. General information

NPI: 1427974880
Provider Name (Legal Business Name): KAYLA PESKO L CSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 KEMPSVILLE RD
NORFOLK VA
23502-3920
US

IV. Provider business mailing address

8524 DEVON ST
NORFOLK VA
23503-3922
US

V. Phone/Fax

Practice location:
  • Phone: 757-261-4600
  • Fax:
Mailing address:
  • Phone: 757-261-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: