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NPI Code Detail

MEDICARE: KEIARRA LYONS

MEDICARE: KEIARRA LYONS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1043727506
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEIARRA LYONS
Provider Business Mailing Address
First Line : 890 SAINT JOHNS PL
Second Line :
City : BROOKLYN
State : NY
Zip : 11216-4306
Country : US
Telephone Number : 347-585-0887
Fax Number :
Provider Business Practice Location Address
First Line : 500 BI COUNTY BLVD STE 450
Second Line :
City : FARMINGDALE
State : NY
Zip : 11735-3995
Country : US
Telephone Number : 718-264-1640
Fax Number : 718-484-0530
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2018
Last Update Date : 01/05/2018

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