Provider Demographics
NPI:1437305232
Name:RICCIOTTI, KELLY (RN, BSN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:RICCIOTTI
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 NYE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LYONS
Mailing Address - State:NY
Mailing Address - Zip Code:14489-9133
Mailing Address - Country:US
Mailing Address - Phone:315-946-5749
Mailing Address - Fax:315-946-5767
Practice Address - Street 1:1519 NYE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LYONS
Practice Address - State:NY
Practice Address - Zip Code:14489-9133
Practice Address - Country:US
Practice Address - Phone:315-946-5749
Practice Address - Fax:315-946-5767
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY577650163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health