Healthcare Provider Details

I. General information

NPI: 1528811106
Provider Name (Legal Business Name): MRS. KELLEY ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 04/11/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 NORTH TRIPHAMMER ROAD SUITE 503
ITHACA NY
14850
US

IV. Provider business mailing address

3452 STATE ROUTE 31 SUITE 2
BALDWINSVILLE NY
13027-9231
US

V. Phone/Fax

Practice location:
  • Phone: 607-266-7682
  • Fax: 607-319-0838
Mailing address:
  • Phone: 315-944-3012
  • Fax: 315-944-3002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1400075217
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: