Healthcare Provider Details

I. General information

NPI: 1437188943
Provider Name (Legal Business Name): AMY O'SHEA KELSEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 STOCKTON BLVD SUITE 2112
SACRAMENTO CA
95817-1418
US

IV. Provider business mailing address

2400 D ST
SACRAMENTO CA
95816-3004
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3861
  • Fax: 916-734-3066
Mailing address:
  • Phone: 916-662-4088
  • Fax: 916-734-3066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA18096
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: