Provider Demographics
NPI:1205025814
Name:KELLY, DEBORAH (FNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:465 COLUMBUS AVE STE 370
Mailing Address - Street 2:
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1336
Mailing Address - Country:US
Mailing Address - Phone:914-769-1600
Mailing Address - Fax:914-769-1610
Practice Address - Street 1:465 COLUMBUS AVE STE 370
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1336
Practice Address - Country:US
Practice Address - Phone:914-769-1600
Practice Address - Fax:914-769-1610
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY330845363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400039208Medicare PIN