Provider Demographics
NPI:1164244133
Name:GAMM, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:GAMM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 WHITE PLAINS ROAD- ENTA 4TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-6802
Mailing Address - Country:US
Mailing Address - Phone:914-333-5801
Mailing Address - Fax:
Practice Address - Street 1:660 WHITE PLAINS ROAD - ENTA
Practice Address - Street 2:FOURTH FLOOR
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-6802
Practice Address - Country:US
Practice Address - Phone:914-984-2552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist