Individual
KEYANA PERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1831 E PASTORIUS ST, PHILADELPHIA, PA 19138-1203
(267) 367-2818
Mailing address
6020 N 19TH ST, PHILADELPHIA, PA 19141-1316
(267) 367-2818
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103575720002
—
PA
Enumeration date
05/28/2020
Last updated
05/28/2020
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