Provider Demographics
NPI:1508097122
Name:BYRD-VAUGHN, MIKYLE SHAKIRA (ND)
Entity Type:Individual
Prefix:DR
First Name:MIKYLE
Middle Name:SHAKIRA
Last Name:BYRD-VAUGHN
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 HOOVER AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3924
Mailing Address - Country:US
Mailing Address - Phone:973-429-7878
Mailing Address - Fax:973-429-7887
Practice Address - Street 1:399 HOOVER AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3924
Practice Address - Country:US
Practice Address - Phone:973-429-7878
Practice Address - Fax:973-429-7887
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00306175F00000X
VT0990000175175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath