Healthcare Provider Details

I. General information

NPI: 1518822030
Provider Name (Legal Business Name): KERRI A BOVE SPECIAL EDUCATION TE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KERRI A MARSHALL

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NYTPS 299 HALLOCK AVE
PORT JEFFERSON STATION NY
11776
US

IV. Provider business mailing address

NYTPS 299 HALLOCK AVE
PORT JEFFERSON STATION NY
11776
US

V. Phone/Fax

Practice location:
  • Phone: 631-708-9592
  • Fax:
Mailing address:
  • Phone: 631-708-9592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: