Healthcare Provider Details

I. General information

NPI: 1417861774
Provider Name (Legal Business Name): KAMIYAH PERSON-GUNTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 BROADHOLLOW RD
MELVILLE NY
11747-4822
US

IV. Provider business mailing address

225 BROADHOLLOW RD STE 402
MELVILLE NY
11747-4899
US

V. Phone/Fax

Practice location:
  • Phone: 631-385-7780
  • Fax:
Mailing address:
  • Phone: 631-385-7780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number733556131
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: