Provider Demographics
NPI:1285064154
Name:CEMELLI, KELLY (PA-C)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:
Last Name:CEMELLI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:BARRIERES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1250 S CEDAR CREST BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6381
Mailing Address - Country:US
Mailing Address - Phone:862-485-5322
Mailing Address - Fax:
Practice Address - Street 1:1250 S CEDAR CREST BLVD STE 310
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6381
Practice Address - Country:US
Practice Address - Phone:862-485-5322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA003160363A00000X
PAMA056548363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant