Provider Demographics
NPI:1487229423
Name:SMITH, KADIAN ANTOINETTE
Entity Type:Individual
Prefix:MRS
First Name:KADIAN
Middle Name:ANTOINETTE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KADIAN
Other - Middle Name:ANTOINETTE
Other - Last Name:FADEYI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:590 AVENUE OF AMERICAS
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-9904
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:170 BROWN PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-4140
Practice Address - Country:US
Practice Address - Phone:917-485-7757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288108164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse