Healthcare Provider Details

I. General information

NPI: 1063546836
Provider Name (Legal Business Name): JAMES SHERIDAN KELLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 STANFORD CT UNIT 701
NAPLES FL
34112-4813
US

IV. Provider business mailing address

1009 CLOVERLEA RD
BALTIMORE MD
21204-6812
US

V. Phone/Fax

Practice location:
  • Phone: 239-566-7425
  • Fax: 239-593-3430
Mailing address:
  • Phone: 239-398-3292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0006137
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberLL712
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: