Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 161683 | NY |
NPI | 1235778341 |
---|---|
Provider Name | Amy Kesavan |
First Address | Rye, NY 10580-2410 |
Second Address | Rye, NY 10580-2410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2020 |
Last Update Date | 06/01/2020 |