Active NPI
Alexandra Kelly
- Speech-Language Pathologist
- Staten Island, NY
National Provider Identifier
1154022739
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 032305-01
- Practice address
- 2907 Amboy Rd
Staten Island, NY 10306-2008 - Phone
- (347) 896-5955
- NPI assigned
- Mar 13, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 032305-01 | NY | Primary |
Addresses
Primary practice location
2907 Amboy Rd
Staten Island, NY 10306-2008
Mailing address
25 Lynbrook CT
Staten Island, NY 10309-4510
Phone (917) 841-6409
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 032305-01 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1678665600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678665600000",
"number": "1154022739",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25 LYNBROOK CT",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103094510",
"telephone_number": "917-841-6409"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2907 AMBOY RD",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103062008",
"telephone_number": "347-896-5955"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "ALEXANDRA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-03-13",
"last_updated": "2023-03-13",
"certification_date": "2023-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "032305-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Staten Island, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.