Healthcare Provider Details

I. General information

NPI: 1962306951
Provider Name (Legal Business Name): KEELIN SEPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 HAIGHT RD
AMENIA NY
12501-5208
US

IV. Provider business mailing address

46 MILL STREET APT. 1 PO BOX 1038
DOVER PLAINS NY
12522
US

V. Phone/Fax

Practice location:
  • Phone: 845-373-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4194621
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: