Healthcare Provider Details

I. General information

NPI: 1902482839
Provider Name (Legal Business Name): KELSEY GRETCHEN BYRNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELSEY JONES

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 CAMBRIDGE ST
BRIGHTON MA
02135-2907
US

IV. Provider business mailing address

960 MASSACHUSETTS AVE STE 2
BOSTON MA
02118-2690
US

V. Phone/Fax

Practice location:
  • Phone: 617-789-2375
  • Fax: 617-789-5177
Mailing address:
  • Phone: 617-414-5405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number1024045
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number1024045
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: