Provider Demographics
NPI:1275262412
Name:CRUICKSHANK, KYLAH TANEE
Entity type:Individual
Prefix:
First Name:KYLAH
Middle Name:TANEE
Last Name:CRUICKSHANK
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 1:8041 SOUTHGATE BLVD APT H5
Mailing Address - Street 2:
Mailing Address - City:NORTH LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-1145
Mailing Address - Country:US
Mailing Address - Phone:617-959-5318
Mailing Address - Fax:
Practice Address - Street 1:4855 W HILLSBORO BLVD STE B12
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4365
Practice Address - Country:US
Practice Address - Phone:754-399-8507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-05
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst