Healthcare Provider Details

I. General information

NPI: 1104434281
Provider Name (Legal Business Name): KEELEY PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W FRANKLIN ST STE 201
HAGERSTOWN MD
21740-4863
US

IV. Provider business mailing address

33 W FRANKLIN ST STE 201
HAGERSTOWN MD
21740-4863
US

V. Phone/Fax

Practice location:
  • Phone: 240-200-0961
  • Fax: 240-201-3033
Mailing address:
  • Phone: 240-200-0961
  • Fax: 240-201-3033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHANNON JEAN SOZZI
Title or Position: OWNER
Credential:
Phone: 864-399-3838