Healthcare Provider Details

I. General information

NPI: 1497459903
Provider Name (Legal Business Name): KELLY ELIZABETH FAHEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

666 W PEREGRINE DR
PALATINE IL
60067-7006
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number135.001192
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: