Healthcare Provider Details

I. General information

NPI: 1972091155
Provider Name (Legal Business Name): KELLY MARIE CHAMBERLIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLY MARIE LUCCHESI MD

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 KUHL AVE
ORLANDO FL
32806-2024
US

IV. Provider business mailing address

1705 KUHL AVE
ORLANDO FL
32806-2024
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-8804
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME181483
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: