Provider Demographics
NPI:1245593516
Name:PEAT-EDJANG, KUSHANA ALECIA (MD)
Entity Type:Individual
Prefix:MRS
First Name:KUSHANA
Middle Name:ALECIA
Last Name:PEAT-EDJANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KUSHANA
Other - Middle Name:ALECIA
Other - Last Name:PEAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:140 PELHAM RD APT 2C
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805-3119
Mailing Address - Country:US
Mailing Address - Phone:914-462-9903
Mailing Address - Fax:
Practice Address - Street 1:140 PELHAM RD APT 2C
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10805-3119
Practice Address - Country:US
Practice Address - Phone:914-462-9903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270220081174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist