Provider Demographics
NPI:1154901916
Name:CHIMENTO, KELLEY ANN (MSED/TSHH)
Entity type:Individual
Prefix:MS
First Name:KELLEY
Middle Name:ANN
Last Name:CHIMENTO
Suffix:
Gender:F
Credentials:MSED/TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 SOUTH WOODS ROAD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-1024
Mailing Address - Country:US
Mailing Address - Phone:515-921-7650
Mailing Address - Fax:516-364-4258
Practice Address - Street 1:72 SOUTH WOODS ROAD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-1024
Practice Address - Country:US
Practice Address - Phone:515-921-7650
Practice Address - Fax:516-364-4258
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2524372355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant