Provider Demographics
NPI:1528797982
Name:HENRY, KADEIDRA SIMONE (LPN)
Entity type:Individual
Prefix:
First Name:KADEIDRA
Middle Name:SIMONE
Last Name:HENRY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 BENBURB ST
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-1403
Mailing Address - Country:US
Mailing Address - Phone:516-329-3298
Mailing Address - Fax:
Practice Address - Street 1:67 BENBURB ST
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-1403
Practice Address - Country:US
Practice Address - Phone:516-329-3298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331373164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse