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NPI Code Detail

MEDICARE: TENESHA SHANTA KELLY-ROBERTS FNP-C

MEDICARE: TENESHA SHANTA KELLY-ROBERTS FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WG0000XGeneral Practice Registered Nurse491143NY
2363LF0000XFamily Nurse PractitionerF355613-01NY

General Provider Information

NPI Number : 1114733417
Entity Type Code : Individual
Provider Name (Legal Business Name) : TENESHA SHANTA KELLY-ROBERTS FNP-C
Provider Business Mailing Address
First Line : 10 WISTERIA DR APT 3C
Second Line :
City : FORDS
State : NJ
Zip : 08863-1130
Country : US
Telephone Number : 917-742-8669
Fax Number :
Provider Business Practice Location Address
First Line : 1468 MADISON AVE
Second Line :
City : NEW YORK
State : NY
Zip : 10029-6508
Country : US
Telephone Number : 212-241-1314
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/10/2024
Last Update Date : 06/11/2026

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