Healthcare Provider Details

I. General information

NPI: 1619364999
Provider Name (Legal Business Name): KISSONIE SANSHIA MCDONALD BAIR M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 N US HWY 441
LADY LAKE FL
32159-3001
US

IV. Provider business mailing address

929 N US HWY 441 STE 201
LADY LAKE FL
32159-3002
US

V. Phone/Fax

Practice location:
  • Phone: 352-783-1767
  • Fax: 352-433-1084
Mailing address:
  • Phone: 352-783-1767
  • Fax: 352-433-1084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME152940
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: