Kelly Jo Costello

Primary specialty

SpecialistTaxonomy code 174400000X

Practice address

299 Hallock Avenue
Port Jefferson, NY 11776

Phone

(540) 532-8002

NPI assigned

Dec 6, 2023

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1701820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701820800000",
    "number": "1700653151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 E MAIN ST # 184",
            "city": "SMITHTOWN",
            "state": "NY",
            "postal_code": "117872804",
            "telephone_number": "540-532-8002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "299 HALLOCK AVENUE",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "11776",
            "telephone_number": "540-532-8002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTELLO",
        "first_name": "KELLY",
        "middle_name": "JO",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-12-06",
        "last_updated": "2023-12-06",
        "certification_date": "2023-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Patrice Coniglio, MA, CCC-SLP
• Kelly Ann Connors, NP
• Kellianne Contri-McCann, PT, DPT, CLT
• Steven C Cortes
• Alfred Joseph Cossari Jr., MD
• Christie Lee Cotty, PA
• Ann L Covitz, MSW
• Michelle Marilyn Craddock, ANP
• Benjamin Craig
• Nicholas Peter Craig, M.D.

• Specialist in Port Jefferson, NY
• Providers in Port Jefferson, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 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.

Verify at the official NPI Registry.