Healthcare Provider Details

I. General information

NPI: 1770864944
Provider Name (Legal Business Name): KENNY BEDOYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 09/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 HEWES ST
BROOKLYN NY
11211-8111
US

IV. Provider business mailing address

267 HEWES ST
BROOKLYN NY
11211-8111
US

V. Phone/Fax

Practice location:
  • Phone: 718-532-1060
  • Fax: 718-218-8264
Mailing address:
  • Phone: 718-532-1060
  • Fax: 718-218-8264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: