Provider Demographics
NPI:1811712151
Name:CAVANAUGH, KAYLEIGH MARIE
Entity type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:MARIE
Last Name:CAVANAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5324 MCFARLAND RD STE 310
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6864
Mailing Address - Country:US
Mailing Address - Phone:919-401-1000
Mailing Address - Fax:919-401-1037
Practice Address - Street 1:5324 MCFARLAND RD STE 310
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6864
Practice Address - Country:US
Practice Address - Phone:919-401-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5021217207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery