Individual
MS. MAUREEN C KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
6001 SHIMER DR, LOCKPORT, NY 14094-6412
(716) 342-3026
(716) 342-3027
Mailing address
6001 SHIMER DR, LOCKPORT, NY 14094-6412
(716) 342-3026
(716) 342-3027
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
001363
CT
363AM0700X
Medical Physician Assistant
Primary
010552
NY
363AM0700X
Medical Physician Assistant
1363
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004245272
—
CT
05
—
08307375
—
NY
01
—
290001363CT02
ANTHEM BCBS
CT
Enumeration date
01/23/2006
Last updated
01/30/2026
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us