Healthcare Provider Details

I. General information

NPI: 1376570879
Provider Name (Legal Business Name): ELIANA V MCKEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W NEW HAVEN AVE
MELBOURNE FL
32904-3747
US

IV. Provider business mailing address

2501 W NEW HAVEN AVE
MELBOURNE FL
32904-3747
US

V. Phone/Fax

Practice location:
  • Phone: 321-725-1999
  • Fax: 321-724-2422
Mailing address:
  • Phone: 321-725-1999
  • Fax: 321-724-2422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number44235
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number44235
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME115201
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: