MEDICARE: KYNAN METOYER PSY.D.

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
1	103G00000X	Clinical Neuropsychologist	PY9505	FL

General Provider Information

NPI Number	:	1437408572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYNAN METOYER PSY.D.

Provider Business Mailing Address
First Line	:	13910 APPALACHIAN TRL
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33325-6502
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 W CORAL WAY
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3860
Country	:	US
Telephone Number	:	808-298-3640
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2012
Last Update Date	:	05/08/2023

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