Provider Demographics
NPI:1083443279
Name:PURYEAR, KEYIANA D
Entity type:Individual
Prefix:
First Name:KEYIANA
Middle Name:D
Last Name:PURYEAR
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 1:260 GREGORY AVE APT B16
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-3817
Mailing Address - Country:US
Mailing Address - Phone:718-928-8087
Mailing Address - Fax:
Practice Address - Street 1:33 MAIDEN LN FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4518
Practice Address - Country:US
Practice Address - Phone:646-745-0170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124163104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker