Healthcare Provider Details

I. General information

NPI: 1932554938
Provider Name (Legal Business Name): PARISA MANSOORI KELLY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 11/02/2025
Certification Date: 11/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5515 W 38TH ST
INDIANAPOLIS IN
46254-2919
US

IV. Provider business mailing address

PO BOX 637764
CINCINNATI OH
45263-7764
US

V. Phone/Fax

Practice location:
  • Phone: 317-880-3838
  • Fax: 317-880-0081
Mailing address:
  • Phone: 317-880-3939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01082705A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: