Provider Demographics
NPI:1649522244
Name:MCKAY, KELLEY LYNN
Entity type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:LYNN
Last Name:MCKAY
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 1:37 COBBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:SHOREHAM
Mailing Address - State:NY
Mailing Address - Zip Code:11786-2311
Mailing Address - Country:US
Mailing Address - Phone:631-849-3447
Mailing Address - Fax:
Practice Address - Street 1:37 COBBLESTONE DR
Practice Address - Street 2:
Practice Address - City:SHOREHAM
Practice Address - State:NY
Practice Address - Zip Code:11786-2311
Practice Address - Country:US
Practice Address - Phone:631-849-3447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist