Healthcare Provider Details

I. General information

NPI: 1053109546
Provider Name (Legal Business Name): KEMISHA NICOLA GARWOOD-CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6214 RIVERDALE AVE APT GB
BRONX NY
10471-1032
US

IV. Provider business mailing address

3485 FISH AVE APT GB
BRONX NY
10469-2273
US

V. Phone/Fax

Practice location:
  • Phone: 718-701-4807
  • Fax:
Mailing address:
  • Phone: 929-365-5579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2924877
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: