Provider Demographics
NPI:1245815992
Name:KELLY, SARAH DRENNAN (RN, IBCLC, CLC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:DRENNAN
Last Name:KELLY
Suffix:
Gender:F
Credentials:RN, IBCLC, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 BLUE POINTE LN
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-2253
Mailing Address - Country:US
Mailing Address - Phone:716-477-5981
Mailing Address - Fax:
Practice Address - Street 1:23 BLUE POINTE LN
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072-2253
Practice Address - Country:US
Practice Address - Phone:716-477-5981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-15
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN784250163W00000X, 163WL0100X
NY926913163W00000X, 163WL0100X
PAPN307141164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse