MEDICARE: DR. KELLY J. MCELLIGOTT AU.D., CCC-A

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	231H00000X	Audiologist	2201002004	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2201002004	OTHER	VA	STATE AUDIOLOGY LICENSE

General Provider Information

NPI Number	:	1104342864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY J. MCELLIGOTT AU.D., CCC-A

Provider Business Mailing Address
First Line	:	9513 AMBERDALE DR
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-1256
Country	:	US
Telephone Number	:	804-373-8224
Fax Number	:	804-369-9658

Provider Business Practice Location Address
First Line	:	9513 AMBERDALE DR
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-1256
Country	:	US
Telephone Number	:	804-373-8224
Fax Number	:	804-369-9658

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

Provider Enumeration Date	:	08/15/2017
Last Update Date	:	02/07/2025

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