Provider Demographics
NPI:1689087058
Name:KELLEHER, YULIYA (RN)
Entity Type:Individual
Prefix:
First Name:YULIYA
Middle Name:
Last Name:KELLEHER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 83RD ST APT 5D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-2946
Mailing Address - Country:US
Mailing Address - Phone:347-553-0577
Mailing Address - Fax:
Practice Address - Street 1:1835 83RD ST APT 5D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-2946
Practice Address - Country:US
Practice Address - Phone:347-553-0577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY633592163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse