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General NPI Number Information
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NPI Number | 1396660874
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Entity Type | Individual
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Provider Name | DEJON PAUL KELLY
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Gender |
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Dates
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Enumeration Date | 08/12/2026
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Last Update Date | 08/12/2026
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Provider Practice Location Address
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Address Line | 340 VETERANS MEMORIAL HWY STE 10
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City | COMMACK
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State | NY
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Zip | 11725-4300
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Country | US
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Telephone | 516-585-7478
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Fax |
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Provider Business Mailing Address
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Address Line | 11809 201ST PL
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City | SAINT ALBANS
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State | NY
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Zip | 11412-3530
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Country | US
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Telephone |
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Fax |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 030052
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License Number State | NY
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