Provider Demographics
NPI:1588231088
Name:NYE, KELLY ANNE (PHD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:NYE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF ROCHESTER MEDICAL CENTER
Mailing Address - Street 2:300 CRITTENDEN BLVD.
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642
Mailing Address - Country:US
Mailing Address - Phone:585-275-3563
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF ROCHESTER MEDICAL CENTER
Practice Address - Street 2:919 WESTFALL RD., BLDG C, SUITE 220
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2628
Practice Address - Country:US
Practice Address - Phone:585-341-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY025320103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program