Healthcare Provider Details

I. General information

NPI: 1538937107
Provider Name (Legal Business Name): AYANA KEELING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 3RD PL
ROOSEVELT NY
11575-1640
US

IV. Provider business mailing address

18 3RD PL
ROOSEVELT NY
11575-1640
US

V. Phone/Fax

Practice location:
  • Phone: 516-712-9744
  • Fax:
Mailing address:
  • Phone: 516-712-9744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number353807
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: