Individual
KIMBERLY A ANNICELLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
79 CROWN ST, PORT JEFFERSON STATION, NY 11776-2801
(631) 949-5894
Mailing address
79 CROWN ST, PORT JEFFERSON STATION, NY 11776-2801
(631) 949-5894
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
11/09/2018
Last updated
11/09/2018
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