Provider Demographics
NPI:1609571702
Name:M KELLEY, CYNTHIA M
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:M
Last Name:M KELLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:M
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CERTMEDICAL INTER
Mailing Address - Street 1:440 E SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-9666
Mailing Address - Country:US
Mailing Address - Phone:619-245-7668
Mailing Address - Fax:
Practice Address - Street 1:440 E SAINT ANDREWS DR
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-9666
Practice Address - Country:US
Practice Address - Phone:619-245-7668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-30
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5674171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter