Provider Demographics
NPI:1649051947
Name:FALANGA, KELLY TAYLOR
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:TAYLOR
Last Name:FALANGA
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 1:4650 FOX RD
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:NY
Mailing Address - Zip Code:14522-9425
Mailing Address - Country:US
Mailing Address - Phone:585-507-9459
Mailing Address - Fax:
Practice Address - Street 1:4650 FOX RD
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:NY
Practice Address - Zip Code:14522-9425
Practice Address - Country:US
Practice Address - Phone:585-507-9459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY717399163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse