Healthcare Provider Details

I. General information

NPI: 1356595391
Provider Name (Legal Business Name): MEREDITH ROSE KELLS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEREDITH ROSE DEMAINA NP

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE.
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 635
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-2964
  • Fax: 585-242-9733
Mailing address:
  • Phone: 585-275-2964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number268085
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN268085
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number383520
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: