Healthcare Provider Details

I. General information

NPI: 1033994231
Provider Name (Legal Business Name): KEELEY PSYCHIATRY OF FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N ORANGE AVE STE 800
ORLANDO FL
32801-2381
US

IV. Provider business mailing address

111 N ORANGE AVE STE 800
ORLANDO FL
32801-2381
US

V. Phone/Fax

Practice location:
  • Phone: 407-205-2178
  • Fax: 240-201-3033
Mailing address:
  • Phone: 407-205-2178
  • Fax: 240-201-3033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHANNON SOZZI
Title or Position: OWNER
Credential:
Phone: 240-200-4037