Healthcare Provider Details

I. General information

NPI: 1619619087
Provider Name (Legal Business Name): KAYLRE M'RAE GREAVES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3274 STEINWAY ST
ASTORIA NY
11103-4006
US

IV. Provider business mailing address

3274 STEINWAY ST
ASTORIA NY
11103-4006
US

V. Phone/Fax

Practice location:
  • Phone: 347-354-1328
  • Fax:
Mailing address:
  • Phone: 347-354-1328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number336642
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: