Healthcare Provider Details

I. General information

NPI: 1083520605
Provider Name (Legal Business Name): HELENA KELLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8745 N WICKHAM RD
MELBOURNE FL
32940-5997
US

IV. Provider business mailing address

3969 JOURNEY CT
CASSELBERRY FL
32707-5256
US

V. Phone/Fax

Practice location:
  • Phone: 321-434-9350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS60900
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: