Provider Demographics
NPI:1023622271
Name:PEAVEY, KYLIE
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:PEAVEY
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 1:334 CENTRAL AVE APT 3L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-3819
Mailing Address - Country:US
Mailing Address - Phone:603-727-6983
Mailing Address - Fax:
Practice Address - Street 1:404 E 91ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-6807
Practice Address - Country:US
Practice Address - Phone:212-369-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist