Individual
MS. KELLY LYNN CASANOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3 OCEAN AVE, MASTIC, NY 11950-4303
(631) 399-0322
Mailing address
3 OCEAN AVE, MASTIC, NY 11950-4303
(631) 399-0322
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
245173-1
NY
Other
Enumeration date
05/10/2013
Last updated
05/10/2013
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