Provider Demographics
NPI:1508202177
Name:BAYER, KENDAL STOKES (LAC)
Entity Type:Individual
Prefix:MS
First Name:KENDAL
Middle Name:STOKES
Last Name:BAYER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MISS
Other - First Name:KENDAL
Other - Middle Name:STOKES
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:292 LINCOLN PL
Mailing Address - Street 2:#2B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-5839
Mailing Address - Country:US
Mailing Address - Phone:917-660-4217
Mailing Address - Fax:
Practice Address - Street 1:36 PLAZA ST E
Practice Address - Street 2:1A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-5048
Practice Address - Country:US
Practice Address - Phone:347-460-6604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004903171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist