Provider Demographics
NPI:1457765190
Name:KUTNER, KAYSHRI
Entity Type:Individual
Prefix:
First Name:KAYSHRI
Middle Name:
Last Name:KUTNER
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 1:54 PERSHING AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-2910
Mailing Address - Country:US
Mailing Address - Phone:646-645-6610
Mailing Address - Fax:
Practice Address - Street 1:54 PERSHING AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-2910
Practice Address - Country:US
Practice Address - Phone:646-645-6610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency