Provider Demographics
NPI:1679788541
Name:LEE, KERRI S (DPM)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:S
Last Name:LEE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-1848
Mailing Address - Country:US
Mailing Address - Phone:860-229-2807
Mailing Address - Fax:860-229-2812
Practice Address - Street 1:201 N MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-1848
Practice Address - Country:US
Practice Address - Phone:860-229-2807
Practice Address - Fax:860-229-2812
Is Sole Proprietor?:No
Enumeration Date:2007-05-13
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006207213E00000X
CT19.000927213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist