Healthcare Provider Details

I. General information

NPI: 1932034410
Provider Name (Legal Business Name): SYDNEY PAIGE KELLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 ISLIP AVE
ISLIP NY
11751-3015
US

IV. Provider business mailing address

38 LAWN ST
GREENLAWN NY
11740-3151
US

V. Phone/Fax

Practice location:
  • Phone: 631-581-6800
  • Fax:
Mailing address:
  • Phone: 631-581-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: