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General NPI Number Information
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NPI Number | 1871274308
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Entity Type | Individual
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Provider Name | KELLY CALLAHAN
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Gender | Female
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Dates
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Enumeration Date | 07/27/2023
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Last Update Date | 07/27/2023
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Provider Practice Location Address
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Address Line | 52 CORPORATE CIR
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City | ALBANY
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State | NY
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Zip | 12203-5176
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Country | US
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Telephone | 518-456-4466
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Fax |
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Provider Business Mailing Address
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Address Line | 3010 PATRICK RD
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City | SCHENECTADY
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State | NY
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Zip | 12303-6011
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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 | 587994
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License Number State | NY
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