Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 266175 | NY |
N | 208C00000X | Colorectal Surgeon | 266175 | NY |
NPI | 1346564044 |
---|---|
Provider Name | Dr. Kristin Kelly |
First Address | Syracuse, NY 13212-4516 |
Second Address | Syracuse, NY 13210-2306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2010 |
Last Update Date | 11/09/2020 |