Provider Demographics
NPI:1710245535
Name:RIELLY, KELLYN SUZANNE (DO)
Entity Type:Individual
Prefix:
First Name:KELLYN
Middle Name:SUZANNE
Last Name:RIELLY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:17183 I 45 S STE 610
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77385-3315
Mailing Address - Country:US
Mailing Address - Phone:281-364-9898
Mailing Address - Fax:281-292-0400
Practice Address - Street 1:17183 I 45 S STE 610
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385-3315
Practice Address - Country:US
Practice Address - Phone:281-364-9898
Practice Address - Fax:281-292-0400
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ9238207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology