Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

MS. Kelly Teresa Marvullo

Individual provider Specialist · NPI 1699022830

MS. Kelly Teresa Marvullo is a Specialist in Lake Ronkonkoma, New York. Licensed in New York. Registered with an NPI since 2012.

Licensed in
NY
In the registry since
2012
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Practice location Address checks out

43 Dorchester Rd
Lake Ronkonkoma, NY 11779-1616
Phone: (631) 278-2556
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Specialist (primary) Taxonomy 174400000X · Licence 1135283 (NY)

Record details

NPI number1699022830
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedAugust 7, 2012
Last updated in NPPESAugust 7, 2012

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