Provider Demographics
NPI:1841047917
Name:TWEDT, KELSEY B (MS)
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:B
Last Name:TWEDT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 DRYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:NY
Mailing Address - Zip Code:14892-9464
Mailing Address - Country:US
Mailing Address - Phone:607-857-0624
Mailing Address - Fax:
Practice Address - Street 1:1080 DRYBROOK RD
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:NY
Practice Address - Zip Code:14892-9464
Practice Address - Country:US
Practice Address - Phone:607-857-0624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1667967221174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty