Individual
OPAL KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS
Contact information
Practice address
768 DELAWARE AVE, BUFFALO, NY 14209-2006
(716) 882-3151
Mailing address
768 DELAWARE AVE, BUFFALO, NY 14209-2006
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
05/24/2022
Last updated
05/24/2022
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