Provider Demographics
NPI:1477855963
Name:OWEN-KELLY, SANDRA L (L AC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:OWEN-KELLY
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1147
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:12758-1147
Mailing Address - Country:US
Mailing Address - Phone:845-439-4471
Mailing Address - Fax:845-439-4471
Practice Address - Street 1:466 OLD RTE 17
Practice Address - Street 2:
Practice Address - City:LIVINGSTON MANOR
Practice Address - State:NY
Practice Address - Zip Code:12758-1147
Practice Address - Country:US
Practice Address - Phone:845-439-4471
Practice Address - Fax:845-439-4471
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002488-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist