Healthcare Provider Details

I. General information

NPI: 1669369187
Provider Name (Legal Business Name): KELLY ANDERS AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3509 N BROAD ST
PHILADELPHIA PA
19140-4105
US

IV. Provider business mailing address

3509 N BROAD ST
PHILADELPHIA PA
19140-4105
US

V. Phone/Fax

Practice location:
  • Phone: 844-570-1767
  • Fax: 215-707-6676
Mailing address:
  • Phone: 215-707-3911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAT007031
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: