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General NPI Number Information
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NPI Number | 1689238958
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Entity Type | Individual
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Provider Name | KEIGHRY MCCLELLAND
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Gender | Female
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Dates
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Enumeration Date | 04/23/2019
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Last Update Date | 04/23/2019
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Provider Practice Location Address
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Address Line | 1900 2ND AVE FL 12
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City | NEW YORK
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State | NY
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Zip | 10029-7406
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Country | US
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Telephone | 212-360-7892
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Fax |
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Provider Business Mailing Address
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Address Line | 2061 STEINWAY ST APT 2R
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City | ASTORIA
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State | NY
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Zip | 11105-1649
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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