MEDICARE: KELLY ROSE DOVI

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	363A00000X	Physician Assistant	032822	NY
2	390200000X	Student in an Organized Health Care Education/Training Program
3	363A00000X	Physician Assistant	7098	CT

General Provider Information

NPI Number	:	1598445553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY ROSE DOVI

Provider Business Mailing Address
First Line	:	11 PEACH BROOK LN
Second Line	:
City	:	BREWSTER
State	:	NY
Zip	:	10509-4614
Country	:	US
Telephone Number	:	914-486-1882
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 ROUTE 52
Second Line	:
City	:	CARMEL
State	:	NY
Zip	:	10512-1200
Country	:	US
Telephone Number	:	845-876-3003
Fax Number	:

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

Provider Enumeration Date	:	07/24/2023
Last Update Date	:	12/04/2025

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Directions to “ KELLY ROSE DOVI ” Practice Location

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