Provider Demographics
NPI:1811548506
Name:DIODATO, KELLI
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:DIODATO
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 1:35 HOPE DRIVE
Mailing Address - Street 2:SUITE 202/204
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2086
Mailing Address - Country:US
Mailing Address - Phone:717-531-3503
Mailing Address - Fax:717-531-4375
Practice Address - Street 1:35 HOPE DRIVE
Practice Address - Street 2:SUITE 202/204
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2086
Practice Address - Country:US
Practice Address - Phone:717-531-3503
Practice Address - Fax:717-531-4375
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife