MEDICARE: KAYCIE HERNANDEZ

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	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1912858408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYCIE HERNANDEZ

Provider Business Mailing Address
First Line	:	5402 217TH ST BAY BAYSIDE
Second Line	:
City	:	BAYSIDE HILLS
State	:	NY
Zip	:	11364-1429
Country	:	US
Telephone Number	:	347-344-2198
Fax Number	:

Provider Business Practice Location Address
First Line	:	5402 217TH ST BAY
Second Line	:
City	:	BAYSIDE HILLS
State	:	NY
Zip	:	11364-1429
Country	:	US
Telephone Number	:	347-344-2198
Fax Number	:

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

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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Directions to “ KAYCIE HERNANDEZ ” Practice Location

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