Provider Demographics
NPI:1871846469
Name:DORMIL, KEISHA (MS)
Entity type:Individual
Prefix:MRS
First Name:KEISHA
Middle Name:
Last Name:DORMIL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:KEISHA
Other - Middle Name:
Other - Last Name:MARTHONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2625 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3979
Mailing Address - Country:US
Mailing Address - Phone:718-769-2698
Mailing Address - Fax:718-943-7035
Practice Address - Street 1:2625 E 14TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3979
Practice Address - Country:US
Practice Address - Phone:718-769-2698
Practice Address - Fax:718-943-7035
Is Sole Proprietor?:No
Enumeration Date:2012-10-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist