| NPI | 1487953675 |
|---|---|
| Former Name | SHANNON KELLY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VT 042.0012902) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2022-07-21 |