Provider Demographics
NPI:1922783521
Name:KELLICI, BIANKA
Entity Type:Individual
Prefix:
First Name:BIANKA
Middle Name:
Last Name:KELLICI
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 1:26 DENMARK AVE
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-5106
Mailing Address - Country:US
Mailing Address - Phone:857-413-0617
Mailing Address - Fax:
Practice Address - Street 1:26 DENMARK AVE
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-5106
Practice Address - Country:US
Practice Address - Phone:857-413-0617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health