Provider Demographics
NPI:1003651092
Name:KELLY, ERICA (DOULA)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 SEDGWICK AVE APT 3H
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-6659
Mailing Address - Country:US
Mailing Address - Phone:929-385-7427
Mailing Address - Fax:
Practice Address - Street 1:1610 SEDGWICK AVE APT 3H
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-6659
Practice Address - Country:US
Practice Address - Phone:929-385-7427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula