Provider Demographics
NPI:1659551638
Name:PELLONI, KELLY NOEL
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:NOEL
Last Name:PELLONI
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:NOEL
Other - Last Name:YORK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13617 OLD FARM DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-6406
Mailing Address - Country:US
Mailing Address - Phone:813-842-6310
Mailing Address - Fax:
Practice Address - Street 1:13617 OLD FARM DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-6406
Practice Address - Country:US
Practice Address - Phone:813-842-6310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist