Active NPI
Khepera Iandiataiyero, PT
- Physical Therapist
- Nottingham, MD
National Provider Identifier
1750746483
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 17169
- Practice address
- 4011 Marjeff PL
Apt C
Nottingham, MD 21236-4514 - Phone
- (410) 917-0524
- NPI assigned
- Dec 23, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 17169 | MD | Primary |
Addresses
Primary practice location
4011 Marjeff PL
Apt C
Nottingham, MD 21236-4514
Mailing address
4011 Marjeff PL
Apt C
Nottingham, MD 21236-4514
Phone (410) 917-0524
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17169 | MD | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1450828800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1450828800000",
"number": "1750746483",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4011 MARJEFF PL",
"address_2": "APT C",
"city": "NOTTINGHAM",
"state": "MD",
"postal_code": "212364514",
"telephone_number": "410-917-0524"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4011 MARJEFF PL",
"address_2": "APT C",
"city": "NOTTINGHAM",
"state": "MD",
"postal_code": "212364514",
"telephone_number": "410-917-0524"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IANDIATAIYERO",
"first_name": "KHEPERA",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-12-23",
"last_updated": "2015-12-23",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MD",
"license": "17169",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nottingham, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.