Healthcare Provider Details

I. General information

NPI: 1922556406
Provider Name (Legal Business Name): KENYA HAMEED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 EAST COURT ST SUITE 1B-1
FLINT MI
48502
US

IV. Provider business mailing address

500 BROOKVIEW CT APT 201
AUBURN HILLS MI
48326
US

V. Phone/Fax

Practice location:
  • Phone: 810-262-2320
  • Fax: 810-239-1281
Mailing address:
  • Phone: 201-956-3327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number6301016816
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: