Kellam, Tavoria
Kellam, Tavoria is an sole proprietor health care provider with primary practice located at 1176 5Th Ave 2253 Third Avenue 3Rd Fl, New York NY 10029-6503. She recently has only one registered license in Other Service Providers / Midwife, which is considered as her primary health care specialty. Kellam, Tavoria can be contacted via phone (212) 289-6650.Contact Information
Primary practice address
1176 5Th Ave 2253 Third Avenue 3Rd Fl
New York NY 10029-6503
Phone: (212) 289-6650
Fax: (212) 360-5088
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Midwife | 176B00000X | F000971-1 | New York |
Profile Details
| NPI number | 1376644096 |
|---|---|
| LBN Legal business name | Kellam, Tavoria |
| Credentials | MW |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 26th, 2006 |
| Last updated | Mar 4th, 2011 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1376644096 | NPPES |
| New York | MEDICAID | 02692359 |
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