KEYONNA WALLACE (NPI# 1861032864) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861032864 |
| Entity Type | Individual |
| Full Name | KEYONNA WALLACE |
| Practice Address |
8002 Kew Gardens Rd Ste 704 Kew Gardens NY 11415-3607 |
| Mailing Address |
79 Glenridge Rd Glenville NY 12302-4523 |
| Practice Telephone | 7185201513 |
| Enumeration Date | 2020-01-08 |
| Last Update Date | 2020-10-19 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
31387 | NY | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 01420795 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 135 W 50th St, New York, NY 100201201 | 2125829100 |
| Street Address |
8002 KEW GARDENS RD STE 704 |
| City | KEW GARDENS |
| State | NY |
| Zip Code | 11415-3607 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851408686 | Todd Sibener | Social Worker | 8002 Kew Gardens Rd Ste 704, Kew Gardens, NY 11415-3607 | 2006-08-25 |
| 1720694557 | Milagros Gomez | Counselor | 8002 Kew Gardens Rd Ste 704, Kew Gardens, NY 11415-3607 | 2020-09-17 |
| 1104477413 | Mathew Elder | Social Worker | 8002 Kew Gardens Rd Ste 704, Kew Gardens, NY 11415-3607 | 2019-09-27 |
| 1972153575 | Leah Josiah | Counselor | 8002 Kew Gardens Rd Ste 704, Kew Gardens, NY 11415-3607 | 2019-09-16 |
| 1962964510 | Dianco Lavenski Holder | Counselor | 8002 Kew Gardens Rd Ste 704, Kew Gardens, NY 11415-3607 | 2019-04-03 |
| 1255827580 | Nadira Mahabir | Social Worker | 8002 Kew Gardens Rd Ste 704, Kew Gardens, NY 11415-3607 | 2018-07-10 |
| 1891293494 | Larelle Gee | Counselor | 8002 Kew Gardens Rd Ste 704, Kew Gardens, NY 11415-3607 | 2018-01-29 |
| 1952813776 | Reama Seeram | Counselor | 8002 Kew Gardens Rd Ste 704, Kew Gardens, NY 11415-3607 | 2017-11-02 |
| 1922525757 | Richard Cawley | Counselor | 8002 Kew Gardens Rd Ste 704, Kew Gardens, NY 11415-3607 | 2017-08-23 |
| 1669997755 | Hui Fang Zhu | Counselor | 8002 Kew Gardens Rd Ste 704, Kew Gardens, NY 11415-3607 | 2017-08-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700492519 | Si Physical Therapy | Clinic/Center | 119-60 Metropolitan Ave, Kew Gardens, NY 11415 | 2020-09-17 |
| 1760036073 | Alina Alayev | Nurse Practitioner | 123-60 83rd Ave 11d, Kew Gardens, NY 11415 | 2019-07-25 |
| 1659860435 | Karolina Pinkhasova | Developmental Therapist | 11917 83rd Ave, Kew Gardens, NY 11415 | 2018-05-07 |
| 1508395989 | Hiral Patel | Physician Assistant | 125-10 Queens Blvd, Suite 2701, Kew Gardens, NY 11415 | 2017-06-08 |
| 1912432147 | Jessica Stefanie Minsky | Speech-Language Pathologist | 82-34 Kew Gardens Rd, Kew Gardens, NY 11415 | 2017-04-25 |
| 1629426697 | Muhammad Usman | Physical Therapist | 8526 126th St Fl 2, Kew Gardens, NY 11415 | 2016-05-31 |
| 1598126260 | Chinonye Benjamin | Licensed Practical Nurse | 85-35 Leffert Blvd, Kew Gardens, Queens, NY 11415 | 2016-03-09 |
| 1730559105 | Mohamed Abaza | Physical Therapist | 119-05 80th Road, Kew Gardens, NY 11415 | 2015-09-29 |
| 1457737306 | Noelle Elizabeth Lenti-nightengale | Registered Nurse | 124-16 85 Avenue, Kew Gardens, NY 11415 | 2015-08-03 |
| 1871996983 | Zinovia Ioannou | Dental Hygienist | 121-56 Metropolitan Ave, Kew Gardens, NY 11415 | 2014-10-02 |
| Find all providers in zip 11415 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902106941 | Teuta Celaj | Counselor | 80 02 Kew Gardens, Kew Gardens, NY 11415 | 2010-10-25 |
| 1922236363 | Lyndee Lichfield | Counselor | 80 02 Kew Gardens Road, Kew Gardens, NY 11415 | 2009-06-24 |
| 1659537702 | Ellen Florence Powell | Counselor | 80-02 Kew Gardens Rd., Suite 704, Kew Gardens, NY 11415 | 2008-07-29 |
| 1457516239 | Ruth Sparks | Counselor | 80-02 Kew Gardens, Suite 704, Kew Gardens, NY 11415 | 2008-07-22 |
| 1720243504 | Myrna Goldstein-chiles | Counselor | 80-02 Kew Gardens Rd, Suite 704, Kew Gardens, NY 11415 | 2008-07-22 |
| 1821253642 | Lillian S Medina | Counselor | 80-20 Kew Gardens, Suite 704, Kew Gardens, NY 11415 | 2008-07-21 |
| 1124283940 | Monica Perry | Counselor | 80-02 Kew Gardens Road, Suite 704, Kew Gardens, NY 11415 | 2008-07-21 |
| 1720694557 | Milagros Gomez | Counselor | 8002 Kew Gardens Rd Ste 704, Kew Gardens, NY 11415-3607 | 2020-09-17 |
| 1972153575 | Leah Josiah | Counselor | 8002 Kew Gardens Rd Ste 704, Kew Gardens, NY 11415-3607 | 2019-09-16 |
| 1962964510 | Dianco Lavenski Holder | Counselor | 8002 Kew Gardens Rd Ste 704, Kew Gardens, NY 11415-3607 | 2019-04-03 |
| Find all providers in KEW GARDENS | ||||
| City | KEW GARDENS |
| Zip Code | 11415 |
Please comment or provide details below to improve the information on KEYONNA WALLACE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.