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

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1902447915

Nicholas Kelly is a Physical Therapist in Private Practice in Bay Shore, New York. Qualified in 2024, 2 years ago. Practices as a sole proprietor.

Years since qualifying
2
In the registry since
2019
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Practice location Address checks out

1089 Manor Ln
Bay Shore, NY 11706-6224
Phone: (631) 649-5834
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1902447915
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedOctober 1, 2019
Last updated in NPPESOctober 1, 2019

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Accepts Medicare assignment Not indicated
Practice locations3 on file with Medicare

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