Healthcare Provider Details

I. General information

NPI: 1306816335
Provider Name (Legal Business Name): KEVIN BRESHIKE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 482 BOX2424
FPO AP
96362
JP

IV. Provider business mailing address

PSC 482 BOX2424
FPO AP
96362
JP

V. Phone/Fax

Practice location:
  • Phone: 011816117342747
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAT001177L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: