Individual
KELLY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4455 MACARTHUR BLVD NW, APT 106, WASHINGTON, DC 20007-2552
(413) 219-1854
Mailing address
2520 30TH AVE, FL 4, ASTORIA, NY 11102-2448
(718) 808-7777
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
307972
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/20/2017
Last updated
05/06/2021
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