Provider Demographics
NPI:1558088781
Name:CEILLY, QUINN MAHANNAH
Entity Type:Individual
Prefix:
First Name:QUINN
Middle Name:MAHANNAH
Last Name:CEILLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:NY
Mailing Address - Zip Code:13042-2144
Mailing Address - Country:US
Mailing Address - Phone:315-460-0666
Mailing Address - Fax:
Practice Address - Street 1:1031 EAST FAYETTE STREET
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-732-3431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician