Provider Demographics
NPI:1174627715
Name:KELLETT, SANDRA C (OD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:C
Last Name:KELLETT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:3630 HILL BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:JEFFERSON VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10535-1502
Mailing Address - Country:US
Mailing Address - Phone:914-962-8111
Mailing Address - Fax:914-962-8160
Practice Address - Street 1:3630 HILL BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:JEFFERSON VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10535-1502
Practice Address - Country:US
Practice Address - Phone:914-962-8111
Practice Address - Fax:914-962-8160
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYVUT005605-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3C0168OtherHEALTHNET OF THE NORTHEAS
NY4242180001OtherMED DURABLE MEDICAL EQUIP
NYC23392OtherEMPIRE BLUE CROSS/SHIELD
NY597002OtherMVP
NY17390POtherHIP
NY2508518OtherAETNA US HEALTH HMO
NY5714530OtherAETNA US HEALTH PPO
NYP-11097425OtherMULTIPLAN
NYP677288OtherOXFORD
NYC23392OtherFEDERAL BLUE CROSS
NYC23392OtherFEDERAL BLUE CROSS
NYC23392Medicare ID - Type Unspecified