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General NPI Number Information
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NPI Number | 1891171096
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Entity Type | Individual
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Provider Name | KAYLEIGH MOON PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/11/2015
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 350 PARRISH ST
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City | CANANDAIGUA
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State | NY
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Zip | 14424-1731
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Country | US
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Telephone | 585-396-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 73 BUFFALO ST STE 100
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City | CANANDAIGUA
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State | NY
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Zip | 14424
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Country | US
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Telephone | 585-396-6515
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Fax | 585-340-4018
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 18869
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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 | 018869
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License Number State | NY
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