Provider Information for 1942975743
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LATANYA BUCKHAM
Sex: Female
NPI: 1942975743
Last Updated: 2024-11-26
Certification Date: 2024-11-26
Certification Date: 2024-11-26
Details
| Name | Value | ||||||||
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| NPI | 1942975743 | ||||||||
| Enumeration Date | 2021-08-12 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 205 HUDSON ST NEW YORK, NY 10013-1803 United States Phone: 347-674-0768 | Fax: | ||||||||
| Primary Practice Address | 205 HUDSON ST NEW YORK, NY 10013-1803 United States Phone: 347-674-0768 | Fax: | ||||||||
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