Provider Demographics
NPI:1649798588
Name:SMALL, KELA NEQUE (CMAA, CMA, CPT, CET)
Entity type:Individual
Prefix:MRS
First Name:KELA
Middle Name:NEQUE
Last Name:SMALL
Suffix:
Gender:F
Credentials:CMAA, CMA, CPT, CET
Other - Prefix:MS
Other - First Name:KELA
Other - Middle Name:NEQUE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:467 COLUMBIA ST
Mailing Address - Street 2:6C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231
Mailing Address - Country:US
Mailing Address - Phone:347-930-9510
Mailing Address - Fax:
Practice Address - Street 1:BROOKLYN NAVY YARD, BUILDING 292
Practice Address - Street 2:4TH FLOOR, SUITE 410
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215
Practice Address - Country:US
Practice Address - Phone:718-435-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC8P3N8Q3247200000X
NYJ4G5A8R7246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other