Individual
KELLY DANIELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2340 BRIGHTON HENRIETTA TOWN LINE RD STE 13, ROCHESTER, NY 14623-2679
(585) 806-5666
Mailing address
PO BOX 90885, ROCHESTER, NY 14609-0885
(585) 295-3809
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04787793
—
NY
Enumeration date
01/29/2022
Last updated
01/29/2022
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