Healthcare Provider Details

I. General information

NPI: 1942380977
Provider Name (Legal Business Name): NICKEEY KISSIAN SALMON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8245 COUNTY ROAD 44 LEG A STE 2
LEESBURG FL
34788-3751
US

IV. Provider business mailing address

8245 COUNTY ROAD 44 LEG A STE 2
LEESBURG FL
34788-3751
US

V. Phone/Fax

Practice location:
  • Phone: 407-955-4445
  • Fax:
Mailing address:
  • Phone: 352-326-3366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberTRN7776
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME99391
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: