Kelly Dolores Desesa, RN, CLT

Primary specialty

Nurse Massage Therapist (NMT)Taxonomy code 163WM1400X

License

557727 Issued in NY

Practice address

34 Bay St
Sag Harbor, NY 11963-3104

Phone

(631) 988-4717

NPI assigned

Sep 30, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Kelly Connolly Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1727654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727654400000",
    "number": "1407674369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 52",
            "city": "SAG HARBOR",
            "state": "NY",
            "postal_code": "119630001",
            "telephone_number": "631-988-4717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34 BAY ST",
            "city": "SAG HARBOR",
            "state": "NY",
            "postal_code": "119633104",
            "telephone_number": "631-988-4717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESESA",
        "first_name": "KELLY",
        "middle_name": "DOLORES",
        "credential": "RN, CLT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-09-30",
        "last_updated": "2024-09-30",
        "certification_date": "2024-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "557727",
            "primary": false
        },
        {
            "code": "163WM1400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Nurse Massage Therapist (NMT)",
            "state": "NY",
            "license": "557727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "CONNOLLY",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Emma Marietta Brown, OTR/L
• Carl F Brandl LMHC
• Jennifer K Cave, PTA
• Nicholas Daba, PTA
• Alexandra Degaetano
• Deborah Disunno, OTA
• Kelly J Downes, DC
• Elise Rachel Duryea, M.A., CCC-SLP
• East End Counseling LCSW PLLC
• East End Sports Chiropractic, PC

• Nurse Massage Therapist (NMT) in Sag Harbor, NY
• Providers in Sag Harbor, NY by specialty
• Nurse Massage Therapist (NMT) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.