Healthcare Provider Details

I. General information

NPI: 1922354810
Provider Name (Legal Business Name): KERRY THERESA IANNONE MS, CAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2012
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 SAINT JOHN ST
MONTICELLO NY
12701-2118
US

IV. Provider business mailing address

11429 TAYPORT LOOP
NEW PORT RICHEY FL
34654-4690
US

V. Phone/Fax

Practice location:
  • Phone: 845-794-4020
  • Fax:
Mailing address:
  • Phone: 845-481-0726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-4097998
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: