Healthcare Provider Details

I. General information

NPI: 1790170918
Provider Name (Legal Business Name): KENIEL FELIX PIERRE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PALMETTO ST
NEW SMYRNA BEACH FL
32168-7327
US

IV. Provider business mailing address

103 MEMORIAL MEDICAL PKWY STE 200
DAYTONA BEACH FL
32117-5121
US

V. Phone/Fax

Practice location:
  • Phone: 386-615-1521
  • Fax:
Mailing address:
  • Phone: 386-615-1521
  • Fax: 386-671-0694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35600
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME139763
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: