Provider Demographics
NPI:1326633405
Name:ELLERBE, KEMBA M
Entity Type:Individual
Prefix:MRS
First Name:KEMBA
Middle Name:M
Last Name:ELLERBE
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 1:14 STEVENS ST APT 5
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-3229
Mailing Address - Country:US
Mailing Address - Phone:914-494-6065
Mailing Address - Fax:914-368-8039
Practice Address - Street 1:14 STEVENS ST APT 5
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10606-3229
Practice Address - Country:US
Practice Address - Phone:914-494-6065
Practice Address - Fax:914-368-8039
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist