Provider Demographics
NPI:1851996565
Name:KONAKANCHI, KERSTINA ELAINE (TEACHER)
Entity Type:Individual
Prefix:MRS
First Name:KERSTINA
Middle Name:ELAINE
Last Name:KONAKANCHI
Suffix:
Gender:F
Credentials:TEACHER
Other - Prefix:MISS
Other - First Name:KERSTINA
Other - Middle Name:ELAINE
Other - Last Name:VIENNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:TEACHER
Mailing Address - Street 1:50 E . NORTH ST.
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1002
Mailing Address - Country:US
Mailing Address - Phone:716-885-8318
Mailing Address - Fax:
Practice Address - Street 1:50 E NORTH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1002
Practice Address - Country:US
Practice Address - Phone:716-885-8318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist