MEDICARE: CECILIA KELLEHER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	500216	NY

General Provider Information

NPI Number	:	1013853183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CECILIA KELLEHER

Provider Business Mailing Address
First Line	:	197 BRYANT AVE
Second Line	:
City	:	FLORAL PARK
State	:	NY
Zip	:	11001-1467
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	402 BEACH 131ST ST
Second Line	:
City	:	BELLE HARBOR
State	:	NY
Zip	:	11694-1537
Country	:	US
Telephone Number	:	917-900-5770
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2026
Last Update Date	:	04/28/2026

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Directions to “ CECILIA KELLEHER ” Practice Location

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