Individual
MRS. KELLY G PASSARELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
87 SPRINGVIEW LN, SUMMERVILLE, SC 29485-9077
(843) 876-7979
Mailing address
PO BOX 602108, CHARLOTTE, NC 28260-2108
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
1710
SC
363A00000X
Physician Assistant
PA08170
TX
Other
Enumeration date
01/09/2012
Last updated
02/02/2024
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