Individual
MS. MICHELE ANN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP NPP
Contact information
Practice address
153 LAKE SHORE RD, PHOENIX HOUSE MEDICAL DEPT, RONKONKOMA, NY 11779
(631) 471-5666
Mailing address
PO BOX 631, MILLER PLACE, NY 11764
(631) 331-0511
(631) 444-7292
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
F380749
NY
Other
Enumeration date
12/27/2006
Last updated
07/08/2007
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