Healthcare Provider Details

I. General information

NPI: 1962472217
Provider Name (Legal Business Name): ELAINE M. KONDROSKI M. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1344 S APOLLO BLVD STE 102
MELBOURNE FL
32901-3183
US

IV. Provider business mailing address

1344 S APOLLO BLVD STE 406
MELBOURNE FL
32901-3185
US

V. Phone/Fax

Practice location:
  • Phone: 321-777-7888
  • Fax: 321-773-7738
Mailing address:
  • Phone: 321-727-2990
  • Fax: 321-724-0455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberME34649
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME34649
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: