Provider Demographics
NPI:1033902648
Name:SAMUEL, KAYLA ELIZABETH (PA)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:ELIZABETH
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:780 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-1706
Mailing Address - Country:US
Mailing Address - Phone:201-836-7664
Mailing Address - Fax:
Practice Address - Street 1:780 CEDAR LN
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-1706
Practice Address - Country:US
Practice Address - Phone:201-836-7664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant