Individual
KANDIE FONROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
110 JERICHO TPKE STE 212, FLORAL PARK, NY 11001-2019
(516) 263-2375
Mailing address
92 WILLETT PL, ROOSEVELT, NY 11575-1822
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
07/28/2022
Last updated
08/19/2022
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