Provider Demographics
NPI:1528381464
Name:GELLY, AVARIAH ALECIA (RN)
Entity Type:Individual
Prefix:MISS
First Name:AVARIAH
Middle Name:ALECIA
Last Name:GELLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1767 E 91ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5405
Mailing Address - Country:US
Mailing Address - Phone:347-668-3788
Mailing Address - Fax:
Practice Address - Street 1:1767 E 91ST ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-5405
Practice Address - Country:US
Practice Address - Phone:347-668-3788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-06
Last Update Date:2010-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY549157163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse