Provider Demographics
NPI:1760018303
Name:REID, KINIKIA SHAKUR (CNM)
Entity Type:Individual
Prefix:MRS
First Name:KINIKIA
Middle Name:SHAKUR
Last Name:REID
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MS
Other - First Name:KINIKIA
Other - Middle Name:SHAKUR
Other - Last Name:COLLIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:48 COACH HOUSE CT
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-7284
Mailing Address - Country:US
Mailing Address - Phone:845-480-6129
Mailing Address - Fax:
Practice Address - Street 1:1400 PELHAM PKWY S
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1197
Practice Address - Country:US
Practice Address - Phone:718-918-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY719685-1163W00000X
NYF001974176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse