Provider Demographics
NPI:1578388815
Name:FAHEY, KIRA LOUISE
Entity type:Individual
Prefix:
First Name:KIRA
Middle Name:LOUISE
Last Name:FAHEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 GREENE AVE APT 2L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-4976
Mailing Address - Country:US
Mailing Address - Phone:646-696-1125
Mailing Address - Fax:
Practice Address - Street 1:1375 GREENE AVE APT 2L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4976
Practice Address - Country:US
Practice Address - Phone:646-696-1125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program