Individual
KELLY SHANNON CARUSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1100 MONTOUR RD, LOYSVILLE, PA 17047-9200
(717) 789-3553
(717) 789-3198
Mailing address
7 DOCK HILL RD, MIDDLEBURG, PA 17842-8910
(570) 837-2123
(570) 837-2185
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS009531L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018455660004
—
PA
Enumeration date
06/06/2006
Last updated
01/28/2016
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