Doctor Name: | RACHEL SHANAN KENNEDY |
NPI Number: | 1801095799 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 4090 |
Business Practice Address: | 435 Medical Group Unit 3215 Apo Ae, NY - 09094 |
Business Phone Number: | 6371462609 |
Business Fax Number: | |
Mailing Address: | 435 Medical Group, Unit 3215 APO |
State: | AE |
Postal Code: | 09094 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 07/12/2007 |
NPI Last Update Date: | 04/20/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 4090 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |