Provider Demographics
NPI:1548882061
Name:KELLY, CYNTHIA RENEE
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:RENEE
Last Name:KELLY
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 1:1413 GIRARD ST NW # 301
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-4611
Mailing Address - Country:US
Mailing Address - Phone:202-492-6743
Mailing Address - Fax:
Practice Address - Street 1:1140 N CAPITOL ST NW APT 304
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-7554
Practice Address - Country:US
Practice Address - Phone:202-355-4701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion