Provider Demographics
NPI:1477290419
Name:KELLEY, MONICA SUZANNE (DPM)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:SUZANNE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 OCEAN PKWY APT D55
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-2163
Mailing Address - Country:US
Mailing Address - Phone:317-501-1589
Mailing Address - Fax:
Practice Address - Street 1:2601 OCEAN PKWY RM 7N33
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7791
Practice Address - Country:US
Practice Address - Phone:718-616-3440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery