Provider Demographics
NPI:1427722958
Name:HARRIS, KELLEY A
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 MAPLE ST # 2
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-3951
Mailing Address - Country:US
Mailing Address - Phone:914-338-8428
Mailing Address - Fax:914-200-5152
Practice Address - Street 1:41 MAPLE ST # 2
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-3951
Practice Address - Country:US
Practice Address - Phone:914-338-8428
Practice Address - Fax:914-200-5152
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-07
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health