Healthcare Provider Details

I. General information

NPI: 1831945146
Provider Name (Legal Business Name): KELLY CEDOR AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2024
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 BLACKSTONE VALLEY PL STE 510
LINCOLN RI
02865-1102
US

IV. Provider business mailing address

291 FLETCHER RD
NORTH KINGSTOWN RI
02852-1608
US

V. Phone/Fax

Practice location:
  • Phone: 401-714-1968
  • Fax:
Mailing address:
  • Phone: 401-714-1968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAUD00103
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: