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General NPI Number Information
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NPI Number | 1679349211
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Entity Type | Individual
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Provider Name | SIOBHAN ELIZABETH KELLY
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Gender | Female
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 02/25/2026
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Provider Practice Location Address
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Address Line | 55 FRUIT STREET
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City | BOSTON
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State | MA
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Zip | 02241-9095
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Country | US
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Telephone | 617-726-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 128 BUNKER HILL ST
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City | CHARLESTOWN
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State | MA
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Zip | 02129-3128
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN2340465
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | RN2340465
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 163WA2000X
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Taxonomy Name | Administrator Registered Nurse
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License Number | RN2340465
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License Number State | MA
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