| NPI | 1154368389 |
|---|---|
| Former Name | KELLY CELESTE MONDELLO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 11526) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: LA A10618) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2023-05-31 |