MEDICARE: KEYIANA PURYEAR LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1104705649
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEYIANA PURYEAR LLC

Provider Business Mailing Address
First Line	:	285 E 16TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-4519
Country	:	US
Telephone Number	:	862-232-9922
Fax Number	:

Provider Business Practice Location Address
First Line	:	285 E 16TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-4519
Country	:	US
Telephone Number	:	862-232-9922
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KEYIANA PURYEAR
Credential	:
Telephone Number	:	862-232-9922

Provider Enumeration Date	:	08/28/2025
Last Update Date	:	08/28/2025

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