Provider Demographics
NPI:1245411495
Name:PASTOR, KELLEY L (PA-C)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:L
Last Name:PASTOR
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:9485 MENTOR AVENUE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-8713
Mailing Address - Country:US
Mailing Address - Phone:440-205-5848
Mailing Address - Fax:440-255-5548
Practice Address - Street 1:9220 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6412
Practice Address - Country:US
Practice Address - Phone:440-354-9924
Practice Address - Fax:877-242-9583
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2021-09-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH50.002708363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant