Individual
KELLY NELIGAN FUCILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, MPAS
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2621
(617) 724-2844
(617) 726-5804
Mailing address
270 BOWDOIN ST, WINTHROP, MA 02152-1735
(516) 528-7927
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA6259
MA
Other
Enumeration date
08/15/2017
Last updated
09/23/2020
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