Provider Demographics
NPI:1942052246
Name:BRODY, KIYA JANE
Entity Type:Individual
Prefix:
First Name:KIYA
Middle Name:JANE
Last Name:BRODY
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 1:13490 GRAN BAY PKWY APT 919
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-7443
Mailing Address - Country:US
Mailing Address - Phone:720-877-6049
Mailing Address - Fax:
Practice Address - Street 1:13490 GRAN BAY PKWY APT 919
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-7443
Practice Address - Country:US
Practice Address - Phone:720-877-6049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician