MEDICARE: YOLANDA DENISE 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	175T00000X	Peer Specialist	CRPA-P-7626	NY

General Provider Information

NPI Number	:	1558192930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOLANDA DENISE KELLY

Provider Business Mailing Address
First Line	:	2404 WOODLAWN AVE
Second Line	:
City	:	NIAGARA FALLS
State	:	NY
Zip	:	14301-1446
Country	:	US
Telephone Number	:	716-940-1987
Fax Number	:

Provider Business Practice Location Address
First Line	:	2404 WOODLAWN AVE
Second Line	:
City	:	NIAGARA FALLS
State	:	NY
Zip	:	14301-1446
Country	:	US
Telephone Number	:	716-940-1987
Fax Number	:

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

Provider Enumeration Date	:	08/08/2024
Last Update Date	:	08/08/2024

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Directions to “ YOLANDA DENISE KELLY ” Practice Location

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