Healthcare Provider Details

I. General information

NPI: 1831833011
Provider Name (Legal Business Name): KYON ALDERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 W NASA BLVD UNIT C-1
MELBOURNE FL
32901-2614
US

IV. Provider business mailing address

3992 SW CHERIBON ST
PORT SAINT LUCIE FL
34953-7046
US

V. Phone/Fax

Practice location:
  • Phone: 321-235-6199
  • Fax:
Mailing address:
  • Phone: 177-228-1127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: