Healthcare Provider Details

I. General information

NPI: 1750176640
Provider Name (Legal Business Name): EDWARD OHENE KYE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GRAND ST
NEW BRITAIN CT
06052-2016
US

IV. Provider business mailing address

61 RACHEL RD APT E
MANCHESTER CT
06042-2140
US

V. Phone/Fax

Practice location:
  • Phone: 860-995-1347
  • Fax:
Mailing address:
  • Phone: 860-995-1347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number178909
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: