Sean Michael Kelly, GNP-BC

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

340958 Issued in NY

Practice address

1 Penn PLZ FL 8
New York, NY 10119-0899

Phone

(347) 213-8011

NPI assigned

Jul 12, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: skelly691767@nychhc.direct-ci.com
• Direct secure messaging: ms_skelly12@landmarkhealth-direct.org

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1373587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603929600000",
    "number": "1215378740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 W 106TH ST OFC",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100253923",
            "telephone_number": "347-501-2299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 PENN PLZ FL 8",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "101190899",
            "telephone_number": "347-213-8011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "550 Warrenville Rd",
            "address_2": "Suite 300",
            "address_purpose": "LOCATION",
            "city": "Lisle",
            "state": "IL",
            "postal_code": "605324308",
            "country_code": "US",
            "telephone_number": "773-332-9616",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "SEAN",
        "middle_name": "MICHAEL",
        "credential": "GNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-12",
        "last_updated": "2020-10-29",
        "certification_date": "2020-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NY",
            "license": "340958",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Kelly, DPT
• Robert E. Kelly
• Ryan Lee Kelly, PT, DPT
• Sarah Kelly, M.D.
• Scott Kelly
• Sean Michael Kelly, MD PHD
• Shana Kelly
• Shannon Kelly
• Shannon Kelly, PA-C
• Susan Kelly, PA-C

• Gerontology Nurse Practitioner in New York, NY
• Providers in New York, NY by specialty
• Gerontology Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.