Provider Demographics
NPI:1295299782
Name:STEPHEN, KEZIA A
Entity type:Individual
Prefix:
First Name:KEZIA
Middle Name:A
Last Name:STEPHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4419 ROCKAWAY BEACH BLVD APT 2Q
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-1240
Mailing Address - Country:US
Mailing Address - Phone:718-414-4347
Mailing Address - Fax:
Practice Address - Street 1:4419 ROCKAWAY BEACH BLVD APT 2Q
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-1240
Practice Address - Country:US
Practice Address - Phone:718-414-4347
Practice Address - Fax:718-284-1724
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist