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Individual
KELLY DOLORES DESESA
Active
Individual
KELLY DOLORES DESESA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, CLT
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
557727
NY
163WM1400X
Nurse Massage Therapist (NMT)
Primary
557727
NY
Other
Enumeration date
09/30/2024
Last updated
09/30/2024
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