MEDICARE: MR. KEVIN M KINDELAN PH.D.

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	103T00000X	Psychologist	PY2345	FL

General Provider Information

NPI Number	:	1134198963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEVIN M KINDELAN PH.D.

Provider Business Mailing Address
First Line	:	1257S PORTOFINO DR A106
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34242-3147
Country	:	US
Telephone Number	:	863-289-8900
Fax Number	:	941-203-5836

Provider Business Practice Location Address
First Line	:	391 E CENTRAL AVE
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33880-3047
Country	:	US
Telephone Number	:	863-297-5463
Fax Number	:	863-299-1384

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

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	11/23/2015

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