Healthcare Provider Details

I. General information

NPI: 1942113394
Provider Name (Legal Business Name): KELLY ROSEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4896 QUARRYSIDE DR
COCOA FL
32927-5965
US

IV. Provider business mailing address

4896 QUARRYSIDE DR
COCOA FL
32927-5965
US

V. Phone/Fax

Practice location:
  • Phone: 573-680-7663
  • Fax:
Mailing address:
  • Phone: 573-680-7663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: