Provider Demographics
NPI:1235778341
Name:KESAVAN, AMY (IBCLC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:KESAVAN
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CHAMBERLAIN ST
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-2410
Mailing Address - Country:US
Mailing Address - Phone:202-445-0947
Mailing Address - Fax:
Practice Address - Street 1:10 CHAMBERLAIN ST
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-2410
Practice Address - Country:US
Practice Address - Phone:202-445-0947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY857705-01163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty