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General NPI Number Information
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NPI Number | 1669019675
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Entity Type | Individual
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Provider Name | KAYLEY MAE SPINELLA PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/09/2019
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 502 W BROAD ST STE 2
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City | FALLS CHURCH
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State | VA
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Zip | 22046-3206
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Country | US
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Telephone | 571-421-8431
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Fax |
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Provider Business Mailing Address
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Address Line | 2570 ROUTE 9W STE 10
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City | CORNWALL
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State | NY
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Zip | 12518-1370
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Country | US
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Telephone | 845-220-3100
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Fax | 845-534-2940
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 024292-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110010225
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License Number State | VA
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