Provider Demographics
NPI:1801146550
Name:KELLY, CARYN FRANCES (MSED)
Entity type:Individual
Prefix:MS
First Name:CARYN
Middle Name:FRANCES
Last Name:KELLY
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 SHORE FRONT PKWY
Mailing Address - Street 2:9M
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-1229
Mailing Address - Country:US
Mailing Address - Phone:917-671-7703
Mailing Address - Fax:
Practice Address - Street 1:7400 SHORE FRONT PKWY
Practice Address - Street 2:9M
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-1229
Practice Address - Country:US
Practice Address - Phone:917-671-7703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY656740121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist