Provider Demographics
NPI:1285027383
Name:SEVERNS, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SEVERNS
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 1:450 USS FLORIDA CT APT 5
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-5051
Mailing Address - Country:US
Mailing Address - Phone:516-547-2251
Mailing Address - Fax:
Practice Address - Street 1:450 USS FLORIDA CT APT 5
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-5051
Practice Address - Country:US
Practice Address - Phone:516-547-2251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist