Individual
COLLEEN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
763 LARKFIELD RD FL 2, COMMACK, NY 11725-3131
(631) 462-2225
(631) 670-2643
Mailing address
763 LARKFIELD RD FL 2, COMMACK, NY 11725-3131
(631) 462-2225
(631) 670-2643
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
010544
AZ
Other
Enumeration date
10/17/2008
Last updated
10/17/2008
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