Provider Demographics
NPI:1770340812
Name:FLOYD, KENNETH LESTER III
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:LESTER
Last Name:FLOYD
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 PROSPECT AVE APT 4B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-3315
Mailing Address - Country:US
Mailing Address - Phone:347-444-2831
Mailing Address - Fax:
Practice Address - Street 1:603 PROSPECT AVE APT 4B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-3315
Practice Address - Country:US
Practice Address - Phone:347-444-2831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3747A0650X, 3747P1801X
372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant