MEDICARE: DR. JAMES SHERIDAN KELLEY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	D0006137	MD
2	207W00000X	Ophthalmology Physician	LL712	FL

General Provider Information

NPI Number	:	1063546836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES SHERIDAN KELLEY MD

Provider Business Mailing Address
First Line	:	1009 CLOVERLEA RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21204-6812
Country	:	US
Telephone Number	:	239-398-3292
Fax Number	:

Provider Business Practice Location Address
First Line	:	2355 STANFORD CT UNIT 701
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34112-4813
Country	:	US
Telephone Number	:	239-566-7425
Fax Number	:	239-593-3430

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	07/21/2022

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