Healthcare Provider Details

I. General information

NPI: 1750103669
Provider Name (Legal Business Name): KYRA SZUGYE AG-ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KYRA STEVENS

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5205 CHAIRMANS CT STE 100
FREDERICK MD
21703-2916
US

IV. Provider business mailing address

5205 CHAIRMANS CT STE 100
FREDERICK MD
21703-2916
US

V. Phone/Fax

Practice location:
  • Phone: 301-696-0012
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR189736
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: