Kenderick Renard Street Jr., IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

License

1972098184 Issued in CT

Practice address

1 Wahoo Ave BLDG 449
Groton, CT 06349-2324

Phone

(860) 694-4123

NPI assigned

Jun 29, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1530230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788825600000",
    "number": "1972098184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "474 BURNINGTREE DR",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063403108",
            "telephone_number": "912-331-3110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WAHOO AVE BLDG 449",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063492324",
            "telephone_number": "860-694-4123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STREET",
        "first_name": "KENDERICK",
        "middle_name": "RENARD",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "IDC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-29",
        "last_updated": "2026-09-08",
        "certification_date": "2026-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": "CT",
            "license": "1972098184",
            "primary": false
        },
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": "CT",
            "license": "1972098184",
            "primary": true
        },
        {
            "code": "247200000X",
            "taxonomy_group": "",
            "desc": "Technician, Other",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Allen Stetler, M.D.
• Michael Charles Stewart Jr., IDC
• Jennifer Stone, RPH.
• Stonington Behavioral Health Inc (Stonington Institute)
• Stop & Shop Supermarket Company LLC (Stop and Shop Pharmacy #682)
• Mary Suarez
• Timothy Edward Suarez, PHARMD
• Jimmy Nazih Suliman, DDS
• Daniel Patrick Sullivan, SUBMARINE IDC
• Darien Sun

• Independent Duty Corpsman in Groton, CT
• Providers in Groton, CT by specialty
• Independent Duty Corpsman in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.