Healthcare Provider Details

I. General information

NPI: 1740709831
Provider Name (Legal Business Name): KELLY ANN PENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3396 5TH AVE
PITTSBURGH PA
15213-3110
US

IV. Provider business mailing address

3396 5TH AVE
PITTSBURGH PA
15213-3110
US

V. Phone/Fax

Practice location:
  • Phone: 914-497-4580
  • Fax:
Mailing address:
  • Phone: 914-497-4580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: