| Doctor Name: | KELLY JEAN HALVONIK |
| NPI Number: | 1093784704 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RPAC |
| License Number: | 004379-1 |
| Business Practice Address: | Interlakes Oncology & Hematology Pc 156 West Ave. Brockport, NY - 14420 |
| Business Phone Number: | 5853950124 |
| Business Fax Number: | 5853950127 |
| Mailing Address: | Interlakes Oncology & Hematology Pc, 211 White Spruce Blvd. ROCHESTER, |
| State: | NY |
| Postal Code: | 14623 |
| Phone Number: | 5854758728 |
| Fax Number: | 5854759411 |
| NPI Enumeration Date: | 03/15/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 004379-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |