Provider Demographics
NPI:1710221148
Name:GRIFFIN, KERRI A (TSHH)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:A
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 HEINZ ST
Mailing Address - Street 2:
Mailing Address - City:HILTON
Mailing Address - State:NY
Mailing Address - Zip Code:14468-1225
Mailing Address - Country:US
Mailing Address - Phone:585-392-2673
Mailing Address - Fax:
Practice Address - Street 1:64 HEINZ ST
Practice Address - Street 2:
Practice Address - City:HILTON
Practice Address - State:NY
Practice Address - Zip Code:14468-1225
Practice Address - Country:US
Practice Address - Phone:585-392-2673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist