Healthcare Provider Details

I. General information

NPI: 1649513276
Provider Name (Legal Business Name): KERRY EILEEN RELLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KERRY EILEEN PHILLIPS M.D.

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 DRUID RD E
CLEARWATER FL
33756-3914
US

IV. Provider business mailing address

708 DRUID RD. E
CLEARWATER FL
33756
US

V. Phone/Fax

Practice location:
  • Phone: 727-446-1097
  • Fax: 833-941-2542
Mailing address:
  • Phone: 727-446-1097
  • Fax: 727-441-2195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME127125
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: