=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013853183
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CECILIA KELLEHER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2026
-----------------------------------------------------
Last Update Date | 04/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 402 BEACH 131ST ST
-----------------------------------------------------
City | BELLE HARBOR
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11694-1537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-900-5770
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 197 BRYANT AVE
-----------------------------------------------------
City | FLORAL PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11001-1467
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 500216
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------