Provider Demographics
NPI:1528409463
Name:VEDOVATO, KELLY ELIZABETH (MS,ED)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ELIZABETH
Last Name:VEDOVATO
Suffix:
Gender:F
Credentials:MS,ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 COACHLIGHT SQ
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:NY
Mailing Address - Zip Code:10548-1241
Mailing Address - Country:US
Mailing Address - Phone:914-233-6540
Mailing Address - Fax:
Practice Address - Street 1:20 COACHLIGHT SQ
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:NY
Practice Address - Zip Code:10548-1241
Practice Address - Country:US
Practice Address - Phone:914-233-6540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist