Healthcare Provider Details

I. General information

NPI: 1134214059
Provider Name (Legal Business Name): KELLEY HULIHAN RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PALISADES DR SUITE 220
ALBANY NY
12205-6433
US

IV. Provider business mailing address

5 PALISADES DR SUITE 220
ALBANY NY
12205-6433
US

V. Phone/Fax

Practice location:
  • Phone: 518-438-5538
  • Fax: 315-448-6325
Mailing address:
  • Phone: 518-438-5538
  • Fax: 315-448-6325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number004338
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: