Provider Demographics
NPI:1669092789
Name:KLUVI, KAYLIN MAE (CSTFA)
Entity type:Individual
Prefix:MRS
First Name:KAYLIN
Middle Name:MAE
Last Name:KLUVI
Suffix:
Gender:F
Credentials:CSTFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 NOWELL LOOP
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-9724
Mailing Address - Country:US
Mailing Address - Phone:386-212-0509
Mailing Address - Fax:
Practice Address - Street 1:504 NOWELL LOOP
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-9724
Practice Address - Country:US
Practice Address - Phone:386-212-0509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-18
Last Update Date:2021-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122409246ZS0410X
205606246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist