Healthcare Provider Details

I. General information

NPI: 1053732115
Provider Name (Legal Business Name): KELSEY SCHULMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2013
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3998 FAIR RIDGE DR SUITE 320
FAIRFAX VA
22033-2907
US

IV. Provider business mailing address

68 SOUTH SERVICE ROAD SUITE 350
MELVILLE NY
11747
US

V. Phone/Fax

Practice location:
  • Phone: 703-295-9360
  • Fax: 703-295-9369
Mailing address:
  • Phone: 516-945-3107
  • Fax: 516-945-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR187906
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024171489
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: