Healthcare Provider Details

I. General information

NPI: 1295102440
Provider Name (Legal Business Name): KAYDIAN MCKOY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6960 SW 25TH ST
MIRAMAR FL
33023-3737
US

IV. Provider business mailing address

6960 SW 25TH ST
MIRAMAR FL
33023
US

V. Phone/Fax

Practice location:
  • Phone: 954-342-7082
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License NumberN5F2Y8M3
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: