Healthcare Provider Details

I. General information

NPI: 1174033138
Provider Name (Legal Business Name): KELLY ANN ZUCCHELLI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY ANN ADAMS CRNA

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 NEW SCOTLAND AVE
ALBANY NY
12208
US

IV. Provider business mailing address

28 WOODRIDGE ST
ALBANY NY
12203-5358
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-3125
  • Fax:
Mailing address:
  • Phone: 518-248-5573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number653676
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: