Provider Demographics
NPI:1124525662
Name:ACKERMAN, KAYLA (MD)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:JASPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:221 BROAD ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-2178
Mailing Address - Country:US
Mailing Address - Phone:315-363-5421
Mailing Address - Fax:315-363-5472
Practice Address - Street 1:221 BROAD ST STE 201
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2178
Practice Address - Country:US
Practice Address - Phone:315-363-5421
Practice Address - Fax:315-363-5472
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY324310-01207Y00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology