Healthcare Provider Details

I. General information

NPI: 1144211061
Provider Name (Legal Business Name): ROBERT KLEID PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6804 CECELIA DR
NEW PORT RICHEY FL
34653-4935
US

IV. Provider business mailing address

6804 CECELIA DR
NEW PORT RICHEY FL
34653-4935
US

V. Phone/Fax

Practice location:
  • Phone: 855-232-0644
  • Fax: 888-546-0488
Mailing address:
  • Phone: 855-232-0644
  • Fax: 888-546-0488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMP 00070800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 910847
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: