Healthcare Provider Details

I. General information

NPI: 1679778302
Provider Name (Legal Business Name): KELLY M SYKES PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 COURT ST SUITE 705
BROOKLYN NY
11201-4421
US

IV. Provider business mailing address

32 COURT ST SUITE 705
BROOKLYN NY
11201-4421
US

V. Phone/Fax

Practice location:
  • Phone: 917-355-2544
  • Fax: 347-789-3025
Mailing address:
  • Phone: 917-355-2544
  • Fax: 347-789-3025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number017178-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: