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NPI Code Detail

MEDICARE: DR. JENNINE KELLEY A.U.D

MEDICARE: DR. JENNINE KELLEY A.U.D
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
1231H00000XAudiologist426CT

General Provider Information

NPI Number : 1265693493
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JENNINE KELLEY A.U.D
Provider Business Mailing Address
First Line : 31 BROADWAY
Second Line :
City : NORTH HAVEN
State : CT
Zip : 06473-2304
Country : US
Telephone Number : 203-234-1324
Fax Number :
Provider Business Practice Location Address
First Line : 31 BROADWAY
Second Line :
City : NORTH HAVEN
State : CT
Zip : 06473-2304
Country : US
Telephone Number : 203-234-1324
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2008
Last Update Date : 04/15/2013

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