Healthcare Provider Details

I. General information

NPI: 1780052670
Provider Name (Legal Business Name): ANGELA KELLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 FERN PL
PLAINVIEW NY
11803-4725
US

IV. Provider business mailing address

16 CHERYL LN N
FARMINGDALE NY
11735-4407
US

V. Phone/Fax

Practice location:
  • Phone: 516-933-4700
  • Fax:
Mailing address:
  • Phone: 631-398-5413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: