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General NPI Number Information
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NPI Number | 1386146330
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Entity Type | Individual
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Provider Name | KIAH EKUNDAYO NYAME ED.D
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Gender | Male
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Dates
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Enumeration Date | 03/06/2018
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Last Update Date | 03/06/2018
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Provider Practice Location Address
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Address Line | 224 ALEXANDER ST
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City | ROCHESTER
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State | NY
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Zip | 14607-4000
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Country | US
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Telephone | 585-922-7770
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Fax |
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Provider Business Mailing Address
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Address Line | 2117 BUFFALO RD # 213
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City | ROCHESTER
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State | NY
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Zip | 14624-1507
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Country | US
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Telephone | 585-770-0536
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC009353
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License Number State | GA
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