Provider Demographics
NPI:1275934424
Name:VELLA, KATHRYN R
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:R
Last Name:VELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19305 NERO AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-1153
Mailing Address - Country:US
Mailing Address - Phone:917-603-3801
Mailing Address - Fax:
Practice Address - Street 1:19305 NERO AVE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-1153
Practice Address - Country:US
Practice Address - Phone:917-603-3801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist