Provider Demographics
NPI:1346685088
Name:BYBERG FLYNN, KATHI ANN
Entity Type:Individual
Prefix:MRS
First Name:KATHI
Middle Name:ANN
Last Name:BYBERG FLYNN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KATHI
Other - Middle Name:ANN
Other - Last Name:BYBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 GARDEN PL
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-7808
Mailing Address - Country:US
Mailing Address - Phone:631-804-1966
Mailing Address - Fax:
Practice Address - Street 1:8 GARDEN PL
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-7808
Practice Address - Country:US
Practice Address - Phone:631-804-1966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist