Individual
KELLY JEANNE BRUNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10 RUSSELL CT, COPIAGUE, NY 11726-1031
(347) 774-5069
Mailing address
10 RUSSELL CT, COPIAGUE, NY 11726-1031
(347) 774-5069
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
NA
NY
Other
Enumeration date
01/08/2026
Last updated
01/08/2026
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