Provider Demographics
NPI:1083064026
Name:KELVEY, AMANDA A (DO)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:A
Last Name:KELVEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-636-5101
Mailing Address - Fax:508-636-3651
Practice Address - Street 1:827 AMERICAN LEGION HWY
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:MA
Practice Address - Zip Code:02790-4128
Practice Address - Country:US
Practice Address - Phone:508-636-5101
Practice Address - Fax:508-636-3651
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA278717207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIRES000Medicare UPIN