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NPI Code Detail

MEDICARE: MRS. KAYLEE NICOLE GENGA

MEDICARE: MRS. KAYLEE NICOLE GENGA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician Assistant6644CT

General Provider Information

NPI Number : 1699531079
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KAYLEE NICOLE GENGA
Provider Business Mailing Address
First Line : 215 DUG RD
Second Line :
City : SOUTH GLASTONBURY
State : CT
Zip : 06073-2006
Country : US
Telephone Number : 860-682-3415
Fax Number :
Provider Business Practice Location Address
First Line : 80 SEYMOUR ST
Second Line :
City : HARTFORD
State : CT
Zip : 06106-3315
Country : US
Telephone Number : 860-545-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2024
Last Update Date : 03/03/2026

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Directions to “ MRS. KAYLEE NICOLE GENGA ” Practice Location

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