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General NPI Number Information
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NPI Number | 1104342864
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Entity Type | Individual
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Provider Name | KELLY J. MCELLIGOTT AU.D., CCC-A
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Gender | Female
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Dates
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Enumeration Date | 08/15/2017
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 9513 AMBERDALE DR
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23236-1256
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Country | US
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Telephone | 804-373-8224
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Fax | 804-369-9658
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Provider Business Mailing Address
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Address Line | 9513 AMBERDALE DR
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23236-1256
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Country | US
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Telephone | 804-373-8224
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Fax | 804-369-9658
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 2201002004
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License Number State | VA
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