Healthcare Provider Details

I. General information

NPI: 1992049274
Provider Name (Legal Business Name): VICTORIA KELLER M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2012
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W COLONIAL DR SUITES 25 & 26
ORLANDO FL
32804-7139
US

IV. Provider business mailing address

1026 CONTRAVEST LN
WINTER SPRINGS FL
32708-6343
US

V. Phone/Fax

Practice location:
  • Phone: 407-650-5977
  • Fax:
Mailing address:
  • Phone: 407-754-6312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: