Healthcare Provider Details

I. General information

NPI: 1659689958
Provider Name (Legal Business Name): KELLI SAROCKY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8775 NORWIN AVE STE 108
IRWIN PA
15642-7705
US

IV. Provider business mailing address

8775 NORWIN AVE STE 108
IRWIN PA
15642-7705
US

V. Phone/Fax

Practice location:
  • Phone: 724-765-1225
  • Fax: 724-765-1227
Mailing address:
  • Phone: 724-765-1225
  • Fax: 724-765-1227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA054441
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: