Active NPI
Kandy Carrillo, PA
- Physician Assistant
- Miami Gardens, FL
National Provider Identifier
1396060034
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9105235
- Practice address
- 21301 NW 2ND Ave
Miami Gardens, FL 33169-2112 - Phone
- (305) 947-4499
- Fax
- (786) 657-2623
- NPI assigned
- Apr 6, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9105235 | FL | Primary |
Addresses
Primary practice location
21301 NW 2ND Ave
Miami Gardens, FL 33169-2112
Mailing address
1145 NE 133Rd St
North Miami, FL 33161-4250
Phone (305) 525-0648
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA9105235 | FL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1270512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468540800000",
"number": "1396060034",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1145 NE 133RD ST",
"city": "NORTH MIAMI",
"state": "FL",
"postal_code": "331614250",
"telephone_number": "305-525-0648"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21301 NW 2ND AVE",
"city": "MIAMI GARDENS",
"state": "FL",
"postal_code": "331692112",
"telephone_number": "305-947-4499",
"fax_number": "786-657-2623"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARRILLO",
"first_name": "KANDY",
"name_prefix": "Ms.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-04-06",
"last_updated": "2016-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9105235",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Miami Gardens, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.