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General NPI Number Information
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NPI Number | 1962428904
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Entity Type | Individual
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Provider Name | ROBERTA MAY KELLY FNP
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Gender | Female
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 06/03/2020
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Provider Practice Location Address
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Address Line | 1543 INWOOD AVE
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City | BRONX
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State | NY
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Zip | 10452-2001
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Country | US
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Telephone | 718-681-8700
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Fax | 718-294-4765
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Provider Business Mailing Address
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Address Line | 3 DUNDERBERG RD.
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City | TOMKINS COVE
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State | NY
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Zip | 10986-1003
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Country | US
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Telephone | 845-270-2793
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 334983
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License Number State | NY
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