Provider Demographics
NPI:1770340150
Name:MCKELVEY, SEAMUS
Entity type:Individual
Prefix:
First Name:SEAMUS
Middle Name:
Last Name:MCKELVEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 PLAYER CT
Mailing Address - Street 2:
Mailing Address - City:DRUMS
Mailing Address - State:PA
Mailing Address - Zip Code:18222-2100
Mailing Address - Country:US
Mailing Address - Phone:215-410-6490
Mailing Address - Fax:
Practice Address - Street 1:200 TRIDENT WAY BLDG 624
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92155-0001
Practice Address - Country:US
Practice Address - Phone:559-381-1279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0054532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer