MEDICARE: KELLY HERNANDEZ M.S. EX.ED.

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	252Y00000X	Early Intervention Provider Agency	910969991	NY

General Provider Information

NPI Number	:	1457509820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY HERNANDEZ M.S. EX.ED.

Provider Business Mailing Address
First Line	:	40 QUAKER LAKE TER
Second Line	:
City	:	ORCHARD PARK
State	:	NY
Zip	:	14127-2826
Country	:	US
Telephone Number	:	716-662-2166
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 QUAKER LAKE TER
Second Line	:
City	:	ORCHARD PARK
State	:	NY
Zip	:	14127-2826
Country	:	US
Telephone Number	:	716-662-2166
Fax Number	:

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

Provider Enumeration Date	:	08/28/2008
Last Update Date	:	08/28/2008

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