Individual
MIRANDA KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4755 OGLETOWN STANTON ROAD, SUITE 5A43, NEWARK, DE 19718-2200
(302) 623-0188
(302) 733-5640
Mailing address
16 CHASE RD, LUMBERTON, NJ 08048-6200
(609) 668-4097
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C5-0012155
DE
Other
Enumeration date
07/05/2023
Last updated
10/04/2024
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