Provider Demographics
NPI:1164899753
Name:SWEENEY, KELLY (RDCS)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:RDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 N NIAGARA ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-3252
Mailing Address - Country:US
Mailing Address - Phone:818-400-1598
Mailing Address - Fax:
Practice Address - Street 1:521 N NIAGARA STREET
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-3252
Practice Address - Country:US
Practice Address - Phone:818-400-1598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1404432471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography