Provider Demographics
NPI:1598648073
Name:RIVERA, KAYCIE MELANIA
Entity type:Individual
Prefix:MS
First Name:KAYCIE
Middle Name:MELANIA
Last Name:RIVERA
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 1:555 ASYLUM AVE APT 313
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-3820
Mailing Address - Country:US
Mailing Address - Phone:860-888-1838
Mailing Address - Fax:
Practice Address - Street 1:555 ASYLUM AVE APT 313
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-3820
Practice Address - Country:US
Practice Address - Phone:860-888-1838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant