MEDICARE: COPELYN ELIZABETH KELLY

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	235Z00000X	Speech-Language Pathologist	035107	NY

General Provider Information

NPI Number	:	1396673844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COPELYN ELIZABETH KELLY

Provider Business Mailing Address
First Line	:	332 E 67TH ST APT 17
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-6282
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 E 3RD ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10009-7322
Country	:	US
Telephone Number	:	212-674-3180
Fax Number	:

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

Provider Enumeration Date	:	05/13/2026
Last Update Date	:	05/13/2026

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Directions to “ COPELYN ELIZABETH KELLY ” Practice Location

Language	Start Address	Practice Location

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