Provider Demographics
NPI:1083130819
Name:SHEW, KYRA
Entity Type:Individual
Prefix:
First Name:KYRA
Middle Name:
Last Name:SHEW
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 1:181 COUNTRY MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:NY
Mailing Address - Zip Code:13856-3179
Mailing Address - Country:US
Mailing Address - Phone:607-865-6017
Mailing Address - Fax:
Practice Address - Street 1:99 MAIN ST
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:NY
Practice Address - Zip Code:13753-1221
Practice Address - Country:US
Practice Address - Phone:607-832-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator