Provider Demographics
NPI:1649068958
Name:KELLY, SHAWN JOSEPH
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:JOSEPH
Last Name:KELLY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 PHEASANT HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-4163
Mailing Address - Country:US
Mailing Address - Phone:856-495-2204
Mailing Address - Fax:
Practice Address - Street 1:24 PHEASANT HOLLOW RD
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-4163
Practice Address - Country:US
Practice Address - Phone:856-495-2204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care