Provider Demographics
NPI:1689477390
Name:BOURDIERD, KELLY
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:
Last Name:BOURDIERD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:B
Other - Last Name:BOURDIERD SANCHEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:KELLY BOURDIERD SANC
Mailing Address - Street 1:526 W 147TH ST APT 53
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-4524
Mailing Address - Country:US
Mailing Address - Phone:646-498-2397
Mailing Address - Fax:
Practice Address - Street 1:526 W 147TH ST APT 53
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-4524
Practice Address - Country:US
Practice Address - Phone:646-498-2397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician