Provider Demographics
NPI:1457849150
Name:KELLEY, SARI MICHELLE
Entity Type:Individual
Prefix:MISS
First Name:SARI
Middle Name:MICHELLE
Last Name:KELLEY
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 1:16929 MEEKLAND AVE APT 209
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-1384
Mailing Address - Country:US
Mailing Address - Phone:510-857-7373
Mailing Address - Fax:
Practice Address - Street 1:16929 MEEKLAND AVE APT 209
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-1384
Practice Address - Country:US
Practice Address - Phone:510-857-7373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor