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General NPI Number Information
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NPI Number | 1275262412
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Entity Type | Individual
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Provider Name | KYLAH TANEE CRUICKSHANK
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Gender | Female
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Dates
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Enumeration Date | 06/05/2022
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 4855 W HILLSBORO BLVD STE B12
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City | COCONUT CREEK
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State | FL
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Zip | 33073-4365
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Country | US
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Telephone | 754-399-8507
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Fax |
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Provider Business Mailing Address
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Address Line | 8041 SOUTHGATE BLVD APT H5
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City | NORTH LAUDERDALE
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State | FL
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Zip | 33068-1145
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Country | US
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Telephone | 617-959-5318
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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