Healthcare Provider Details

I. General information

NPI: 1174901458
Provider Name (Legal Business Name): KAYLAN BRADY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 TURIN TERRACE SUITE 220
ST AUGUSTINE FL
32092
US

IV. Provider business mailing address

PO BOX 100296
GAINESVILLE FL
32610-0296
US

V. Phone/Fax

Practice location:
  • Phone: 904-819-3000
  • Fax: 904-819-4426
Mailing address:
  • Phone: 352-627-9350
  • Fax: 352-273-9054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME140045
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: