Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Shyla Imani Kissoon, PA-C

Individual provider Medical Physician Assistant · NPI 1790399483

Shyla Imani Kissoon, PA-C is a Medical Physician Assistant in South Orange, New Jersey. Works from 2 locations. Licensed in Florida and New Jersey.

Licensed in
FL, NJ
In the registry since
2020
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

See every abbreviation used in this directory →

Practice location Address checks out

20 Valley St Ste 320
South Orange, NJ 07079-2881
Phone: (973) 313-1113
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 4830 Nw 7th St, Plantation, FL 33317-1410 — (954) 655-7641

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 25MP00614400 (NJ)
Medical Physician Assistant Taxonomy 363AM0700X · Licence 9113364 (FL)

Record details

NPI number1790399483
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedSeptember 1, 2020
Last updated in NPPESAugust 9, 2021
Certification dateAugust 9, 2021

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