Provider Demographics
NPI:1780353789
Name:DILEONARDO-FLYNN, KELLY ANNE (LMT)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANNE
Last Name:DILEONARDO-FLYNN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:915 BROADWAY STE 1106
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-7127
Mailing Address - Country:US
Mailing Address - Phone:212-475-8104
Mailing Address - Fax:212-475-4443
Practice Address - Street 1:915 BROADWAY STE 1106
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7127
Practice Address - Country:US
Practice Address - Phone:212-475-8104
Practice Address - Fax:212-475-4443
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013900225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist