Provider Demographics
NPI:1497927685
Name:KELLY, EVELYN (AUD)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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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:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:299 FAUNCE CORNER RD
Practice Address - Street 2:
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-6244
Practice Address - Country:US
Practice Address - Phone:508-995-0700
Practice Address - Fax:508-973-1355
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA863231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1497927685OtherFALLON COMMUNITY HEALTH PLAN
MA9924352OtherAENTA
MA1497927685OtherNEIGHBORHOOD HEALTH PLAN
MA1497927685OtherFALLON COMMUNITY HEALTH PLAN