Healthcare Provider Details

I. General information

NPI: 1124953708
Provider Name (Legal Business Name): KEIRA ELIZABETH PINARDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 ALLENWOOD LN
SHADY SPRING WV
25918-8093
US

IV. Provider business mailing address

109 ALLENWOOD LN
SHADY SPRING WV
25918-8093
US

V. Phone/Fax

Practice location:
  • Phone: 681-220-8461
  • Fax:
Mailing address:
  • Phone: 681-220-8461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number3747P1801X
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: