Provider Demographics
NPI:1477821379
Name:KELLEY, MARIEA REBECCA (RPA-C)
Entity Type:Individual
Prefix:MS
First Name:MARIEA
Middle Name:REBECCA
Last Name:KELLEY
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:MARIEA
Other - Middle Name:REBECCA
Other - Last Name:SINGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-2822
Mailing Address - Country:US
Mailing Address - Phone:347-666-2803
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-005162RX363A00000X
NY015290363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant