MEDICARE: SHAWNA 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	101YM0800X	Mental Health Counselor	PC011130	PA

General Provider Information

NPI Number	:	1790240505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWNA KELLY

Provider Business Mailing Address
First Line	:	11279 PERRY HWY
Second Line	:
City	:	WEXFORD
State	:	PA
Zip	:	15090-9381
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1580 MCLAUGHLIN RUN RD STE 105
Second Line	:
City	:	UPPER SAINT CLAIR
State	:	PA
Zip	:	15241-3100
Country	:	US
Telephone Number	:	412-841-1163
Fax Number	:

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

Provider Enumeration Date	:	02/06/2019
Last Update Date	:	10/21/2024

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Directions to “ SHAWNA KELLY ” Practice Location

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