MEDICARE: DR. FORTUNEE KAYRA-STUART PH.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	103T00000X	Psychologist	PSY9810	CA

General Provider Information

NPI Number	:	1821149931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FORTUNEE KAYRA-STUART PH.D.

Provider Business Mailing Address
First Line	:	791A TAFT AVE
Second Line	:
City	:	ALBANY
State	:	CA
Zip	:	94706-1026
Country	:	US
Telephone Number	:	510-526-9506
Fax Number	:	510-526-9506

Provider Business Practice Location Address
First Line	:	2550 9TH ST
Second Line	:	SUITE 115
City	:	BERKELEY
State	:	CA
Zip	:	94710-2549
Country	:	US
Telephone Number	:	510-526-9506
Fax Number	:	510-526-9506

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

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	07/08/2007

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