Provider Demographics
NPI:1629761739
Name:SCHWARTZ, KALY RAE
Entity Type:Individual
Prefix:
First Name:KALY
Middle Name:RAE
Last Name:SCHWARTZ
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 1:155 LASA COMMONS CIR APT 210
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-8792
Mailing Address - Country:US
Mailing Address - Phone:215-360-5816
Mailing Address - Fax:
Practice Address - Street 1:1838 GREENE TREE RD STE 245
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-7110
Practice Address - Country:US
Practice Address - Phone:410-753-3317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program