Healthcare Provider Details

I. General information

NPI: 1497680052
Provider Name (Legal Business Name): KELLEY RAE CARBONE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

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

1037 MAIN ST
PEEKSKILL NY
10566-2913
US

IV. Provider business mailing address

49 PRICES SWITCH RD
WARWICK NY
10990-2325
US

V. Phone/Fax

Practice location:
  • Phone: 914-402-7400
  • Fax:
Mailing address:
  • Phone: 845-653-6284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number312876
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: