Kelley, Deloisa I

Kelley, Deloisa I is an individual health care provider with primary practice located at 42 N Main St , Canandaigua NY 14424-1446. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health. Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health is her primary health care specialty. Kelley, Deloisa I can be contacted via phone (585) 919-0014.

Contact Information

Primary practice address
42 N Main St Canandaigua NY 14424-1446
Phone: (585) 919-0014
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 404488 New York

Profile Details

NPI number 1134383946
LBN Legal business name Kelley, Deloisa I
Credentials PMHNP
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 11th, 2008
Last updated Oct 25th, 2022 - about 3 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1134383946 NPPES
New York MEDICAID 01420800

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