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NPI Code Detail

MEDICARE: KELSEY L BUNYAK M.ED

MEDICARE: KELSEY L BUNYAK M.ED
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
1103K00000XBehavior Analyst2222NC

General Provider Information

NPI Number : 1659975159
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELSEY L BUNYAK M.ED
Provider Business Mailing Address
First Line : 134 INFIELD CT
Second Line :
City : MOORESVILLE
State : NC
Zip : 28117-8026
Country : US
Telephone Number : 704-799-6824
Fax Number : 704-799-6825
Provider Business Practice Location Address
First Line : 1777 OLD EARNHARDT RD
Second Line :
City : KANNAPOLIS
State : NC
Zip : 28083-8023
Country : US
Telephone Number : 704-799-6824
Fax Number : 704-799-6825
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/24/2020
Last Update Date : 11/11/2024

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