Provider Demographics
NPI:1528266053
Name:MAHANEY, KELLY B (MD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:B
Last Name:MAHANEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:BRIANNE
Other - Last Name:MAHANEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:300 PASTEUR DR RM 211
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-2200
Mailing Address - Country:US
Mailing Address - Phone:650-497-8775
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DR RM 211
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-497-8775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR8192207T00000X
IA41124207T00000X
VA0101258492207T00000X
CAA149898207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery