Provider Demographics
NPI:1528597804
Name:ROBERTS, KAYDIAN KARYL
Entity Type:Individual
Prefix:
First Name:KAYDIAN
Middle Name:KARYL
Last Name:ROBERTS
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 1:767 INDEPENDENCE DR UNIT D101
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-2669
Mailing Address - Country:US
Mailing Address - Phone:774-521-7174
Mailing Address - Fax:
Practice Address - Street 1:767 INDEPENDENCE DR
Practice Address - Street 2:APT D101
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601
Practice Address - Country:US
Practice Address - Phone:774-521-7174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst