Provider Demographics
NPI:1740709831
Name:PENA, KELLY ANN
Entity type:Individual
Prefix:
First Name:KELLY ANN
Middle Name:
Last Name:PENA
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 1:1300 MIDLAND AVE
Mailing Address - Street 2:APT# A35
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704
Mailing Address - Country:US
Mailing Address - Phone:914-497-4580
Mailing Address - Fax:
Practice Address - Street 1:138 READE ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3968
Practice Address - Country:US
Practice Address - Phone:212-608-9661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist