Provider Demographics
NPI:1871207878
Name:CYRIL, KETTIA
Entity type:Individual
Prefix:
First Name:KETTIA
Middle Name:
Last Name:CYRIL
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 1:13918 CASTLE BLVD APT 304
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-4954
Mailing Address - Country:US
Mailing Address - Phone:301-455-9202
Mailing Address - Fax:
Practice Address - Street 1:13918 CASTLE BLVD APT 304
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-4954
Practice Address - Country:US
Practice Address - Phone:301-455-9202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00191251376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide