Provider Demographics
NPI:1124351572
Name:COLON-SANCHEZ, KAITY (PA)
Entity type:Individual
Prefix:
First Name:KAITY
Middle Name:
Last Name:COLON-SANCHEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W KALEY ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806
Mailing Address - Country:US
Mailing Address - Phone:407-423-2581
Mailing Address - Fax:407-849-6470
Practice Address - Street 1:20 W KALEY ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2931
Practice Address - Country:US
Practice Address - Phone:407-423-2581
Practice Address - Fax:407-849-6470
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9106114363A00000X
FLPA9106114363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004315200Medicaid