Individual
MRS. LAURA JEAN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, CSO, CDN
Contact information
Practice address
650 COMMACK RD, COMMACK, NY 11725-5404
(631) 623-4000
(631) 864-2787
Mailing address
650 COMMACK RD, COMMACK, NY 11725-5404
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
7184206
NY
133V00000X
Registered Dietitian
Primary
956635
NY
Other
Enumeration date
06/22/2011
Last updated
06/22/2011
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