Provider Demographics
NPI:1386010056
Name:KELLY, DARA
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:
Last Name:KELLY
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 1:414 MAPLE AVE
Mailing Address - Street 2:STE 800
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-5556
Mailing Address - Country:US
Mailing Address - Phone:518-584-0578
Mailing Address - Fax:518-584-2568
Practice Address - Street 1:400 PATROON CREEK BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-5013
Practice Address - Country:US
Practice Address - Phone:518-701-2000
Practice Address - Fax:518-701-2020
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002613-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist