Provider Demographics
NPI:1609472455
Name:PICCIANO, KELSEY JOANN
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:JOANN
Last Name:PICCIANO
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 1:200 MARINA DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS
Mailing Address - State:NJ
Mailing Address - Zip Code:07732-1564
Mailing Address - Country:US
Mailing Address - Phone:646-919-7561
Mailing Address - Fax:
Practice Address - Street 1:200 MARINA DR
Practice Address - Street 2:
Practice Address - City:HIGHLANDS
Practice Address - State:NJ
Practice Address - Zip Code:07732-1564
Practice Address - Country:US
Practice Address - Phone:646-919-7561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant