Provider Demographics
NPI:1194068106
Name:CHRISTENSON, KELLIE (MD)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:CHRISTENSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:STONY BROOK UNIVERSITY HOSPITAL: PEDIATRICS
Mailing Address - Street 2:HSC T-11 / 040
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8111
Mailing Address - Country:US
Mailing Address - Phone:631-444-2020
Mailing Address - Fax:631-444-2894
Practice Address - Street 1:STONY BROOK UNIVERSITY HOSPITAL: PEDIATRICS
Practice Address - Street 2:HSC T-11 / 040
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8111
Practice Address - Country:US
Practice Address - Phone:631-444-2020
Practice Address - Fax:631-444-2894
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2024-06-18
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Provider Licenses
StateLicense IDTaxonomies
NY2831902084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology