Healthcare Provider Details

I. General information

NPI: 1528539467
Provider Name (Legal Business Name): SHARIT MELISSA KELLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHARE MELISSA KELLEY

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2666 N MCMULLEN BOOTH RD APT 1032
CLEARWATER FL
33761-4048
US

IV. Provider business mailing address

2666 N MCMULLEN BOOTH RD APT 1032
CLEARWATER FL
33761-4048
US

V. Phone/Fax

Practice location:
  • Phone: 727-804-0261
  • Fax:
Mailing address:
  • Phone: 727-804-0261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberR9266
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMT3965
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: