Healthcare Provider Details

I. General information

NPI: 1356978779
Provider Name (Legal Business Name): MS. RACHEL BAILAH KANSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NW 16TH ST
MIAMI FL
33125-1624
US

IV. Provider business mailing address

145 SW 13TH ST APT 724
MIAMI FL
33130-4397
US

V. Phone/Fax

Practice location:
  • Phone: 305-575-3148
  • Fax:
Mailing address:
  • Phone: 732-832-6820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY2369
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: