MEDICARE: KRISTEN ANN DOUGHERTY

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	252Y00000X	Early Intervention Provider Agency	1114167	NY

General Provider Information

NPI Number	:	1275421786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN ANN DOUGHERTY

Provider Business Mailing Address
First Line	:	2861 CHESTER ST
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-1233
Country	:	US
Telephone Number	:	516-528-1915
Fax Number	:

Provider Business Practice Location Address
First Line	:	2861 CHESTER ST
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-1233
Country	:	US
Telephone Number	:	516-528-1915
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2025
Last Update Date	:	06/24/2025

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Directions to “ KRISTEN ANN DOUGHERTY ” Practice Location

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