Individual provider · Type 1 NPI

Kelly Jo Costello

Specialist · Port Jefferson, NY

NPI number 1700653151 Active

Practice location

299 Hallock Avenue
Port Jefferson, NY 11776

Call (540) 532-8002 Map

Mailing address

34 E Main St # 184
Smithtown, NY 11787-2804

Specialties and licenses

TaxonomyCodeLicense
Specialist Primary 174400000XNone listed

Specialist: An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

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About NPI 1700653151

Kelly Jo Costello's National Provider Identifier is 1700653151, issued on Dec 6, 2023. The primary taxonomy on file is Specialist (174400000X), and the practice location is in Port Jefferson, NY. The record was last updated on Dec 6, 2023.