Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | C1-0003808 | DE |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | C10003808 | DE |
NPI | 1013161512 |
---|---|
Provider Name | Dr. Kelly Anne Fanto |
First Address | Lewes, DE 19958-0037 |
Second Address | Lewes, DE 19958-0037 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2008 |
Last Update Date | 16/12/2008 |