Healthcare Provider Details

I. General information

NPI: 1285273003
Provider Name (Legal Business Name): KELLI ANN CANO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2019
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 N KENDALL DR STE 407W
MIAMI FL
33176-2132
US

IV. Provider business mailing address

PO BOX 198054
ATLANTA GA
30384-8054
US

V. Phone/Fax

Practice location:
  • Phone: 786-596-3876
  • Fax: 786-533-9989
Mailing address:
  • Phone: 786-596-3876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9113496
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: