Healthcare Provider Details

I. General information

NPI: 1891971552
Provider Name (Legal Business Name): KELLY CHRISTINE CHAMBERLAIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 4TH AVENUE CIR E
BRADENTON FL
34208-5623
US

IV. Provider business mailing address

5323 4TH AVENUE CIR E
BRADENTON FL
34208-5623
US

V. Phone/Fax

Practice location:
  • Phone: 941-745-5115
  • Fax: 941-315-6742
Mailing address:
  • Phone: 941-745-5115
  • Fax: 941-315-6742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number125047394
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME101410
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: