Provider Demographics
NPI:1578093001
Name:DAILEY, KELLYANNE (LPN)
Entity Type:Individual
Prefix:
First Name:KELLYANNE
Middle Name:
Last Name:DAILEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BROOK CIR
Mailing Address - Street 2:
Mailing Address - City:ISLIP TERRACE
Mailing Address - State:NY
Mailing Address - Zip Code:11752-2105
Mailing Address - Country:US
Mailing Address - Phone:631-645-3816
Mailing Address - Fax:
Practice Address - Street 1:1 BROOK CIR
Practice Address - Street 2:
Practice Address - City:ISLIP TERRACE
Practice Address - State:NY
Practice Address - Zip Code:11752-2105
Practice Address - Country:US
Practice Address - Phone:631-645-3816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY321366164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse