Healthcare Provider Details

I. General information

NPI: 1104518760
Provider Name (Legal Business Name): KYLEE MAE STONEBARGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2631 MERRICK RD STE 302
BELLMORE NY
11710-5784
US

IV. Provider business mailing address

7066 MOUNTAIN BRUSH CIR
HIGHLANDS RANCH CO
80130-5316
US

V. Phone/Fax

Practice location:
  • Phone: 516-308-4966
  • Fax:
Mailing address:
  • Phone: 303-518-1761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: