Provider Demographics
NPI:1205587805
Name:STOCKDALE, KELLY SYMONE
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:SYMONE
Last Name:STOCKDALE
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 1:1884 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:EAST CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-4744
Mailing Address - Country:US
Mailing Address - Phone:216-972-7784
Mailing Address - Fax:
Practice Address - Street 1:1884 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:EAST CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-4744
Practice Address - Country:US
Practice Address - Phone:216-972-7784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker