Healthcare Provider Details

I. General information

NPI: 1043176183
Provider Name (Legal Business Name): KANDICE D KERSHAW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2026
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 NEPTUNE RD STE P12
POUGHKEEPSIE NY
12601-5571
US

IV. Provider business mailing address

3 NEPTUNE RD STE P12
POUGHKEEPSIE NY
12601-5571
US

V. Phone/Fax

Practice location:
  • Phone: 845-276-3906
  • Fax:
Mailing address:
  • Phone: 845-276-3906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: