MEDICARE: CYNTHIA RENEE KELLY

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
1	372600000X	Adult Companion

General Provider Information

NPI Number	:	1548882061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA RENEE KELLY

Provider Business Mailing Address
First Line	:	1413 GIRARD ST NW # 301
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20009-4611
Country	:	US
Telephone Number	:	202-492-6743
Fax Number	:

Provider Business Practice Location Address
First Line	:	1140 N CAPITOL ST NW APT 304
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-7554
Country	:	US
Telephone Number	:	202-355-4701
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2020
Last Update Date	:	05/07/2020

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Directions to “ CYNTHIA RENEE KELLY ” Practice Location

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