Individual
DELOISA I KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
42 N MAIN ST, CANANDAIGUA, NY 14424-1446
(585) 919-0014
Mailing address
42 N MAIN ST, CANANDAIGUA, NY 14424-1446
(585) 919-0014
(585) 919-0014
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
404488
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01420800
—
NY
Enumeration date
07/11/2008
Last updated
10/25/2022
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