Healthcare Provider Details

I. General information

NPI: 1477998599
Provider Name (Legal Business Name): KAYLESH K. PANDYA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 05/16/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 W RAILROAD AVE # 234
SHELTON WA
98584-3522
US

IV. Provider business mailing address

625 W RAILROAD AVE # 234
SHELTON WA
98584-3522
US

V. Phone/Fax

Practice location:
  • Phone: 360-529-1234
  • Fax: 360-284-2535
Mailing address:
  • Phone: 360-529-1234
  • Fax: 360-284-2535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberOS14868
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS14868
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP61475133
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: