Healthcare Provider Details

I. General information

NPI: 1568766442
Provider Name (Legal Business Name): SIOK-HIAN TAY-KELLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2011
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 BLAKE WILBUR DRIVE GASTROINTESTINAL ONCOLOGY STANFORD CANCER CENTER,
STANFORD CA
94305-2205
US

IV. Provider business mailing address

1804 EMBARCADERO RD STE 100
PALO ALTO CA
94303-3341
US

V. Phone/Fax

Practice location:
  • Phone: 650-498-6000
  • Fax:
Mailing address:
  • Phone: 650-723-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number19493
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number3322
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: