Individual
KENDALL GODT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2539 MIDDLE COUNTRY RD, CENTEREACH, NY 11720-3551
(631) 737-6434
Mailing address
645 BELLE TERRE RD APT 76, PORT JEFFERSON, NY 11777-1943
(631) 848-9213
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
796294
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F405021-01
NY
Other
Enumeration date
06/12/2023
Last updated
06/12/2023
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