Individual
MISS SHAUNA KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1600 JOSEPH DR, BRYAN, TX 77802-1502
(979) 776-2411
(979) 776-4986
Mailing address
64 DANBURY RD, WILTON, CT 06897-4429
(800) 278-0332
(800) 970-5001
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
1195167
TX
Other
Enumeration date
02/05/2011
Last updated
02/05/2011
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