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NPI Code Detail

MEDICARE: SANIYAH MCKELLERY

MEDICARE: SANIYAH MCKELLERY
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1568398030
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANIYAH MCKELLERY
Provider Business Mailing Address
First Line : 5418 REVERE DR
Second Line :
City : LOUISVILLE
State : KY
Zip : 40218-4326
Country : US
Telephone Number : 502-641-8142
Fax Number :
Provider Business Practice Location Address
First Line : 11401 BLUEGRASS PKWY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-2349
Country : US
Telephone Number : 888-515-1793
Fax Number : 888-515-1793
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2026
Last Update Date : 06/22/2026

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Directions to “ SANIYAH MCKELLERY ” Practice Location

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