Individual
SHANTELL KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13320 ROOSEVELT AVE APT 8D, FLUSHING, NY 11354-5203
(347) 663-0048
Mailing address
13320 ROOSEVELT AVE, FLUSHING, NY 11354-5262
(347) 663-0048
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
01/05/2026
Last updated
01/23/2026
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