Provider Demographics
NPI:1003852393
Name:MERANDY, KYLE DAVID (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:DAVID
Last Name:MERANDY
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
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Mailing Address - Street 1:35-03 29TH STREET
Mailing Address - Street 2:APT 2B
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-3134
Mailing Address - Country:US
Mailing Address - Phone:646-246-4317
Mailing Address - Fax:
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:STARR 900
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:212-746-5467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2013-11-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYF304356-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health