Provider Demographics
NPI:1629768452
Name:PIEDRAHITA, KELLY CHRISTINE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:CHRISTINE
Last Name:PIEDRAHITA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 E 57TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 COCOANUT ROW SUITE 1000
Practice Address - Street 2:
Practice Address - City:PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33480
Practice Address - Country:US
Practice Address - Phone:917-202-1531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9117426363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant