| Doctor Name: | DR. SUSAN KELLY-WEEDER |
| NPI Number: | 1093121766 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP-BC |
| License Number: | 151039 |
| Business Practice Address: | 140 Commonwealth Ave Cushing Hall #420 Chestnut Hill, MA - 024673800 |
| Business Phone Number: | 6175528018 |
| Business Fax Number: | |
| Mailing Address: | 140 Commonwealth Ave, Cushing Hall #420 CHESTNUT HILL |
| State: | MA |
| Postal Code: | 024673800 |
| Phone Number: | 6175528018 |
| Fax Number: | |
| NPI Enumeration Date: | 07/02/2014 |
| NPI Last Update Date: | 07/02/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 151039 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |