Healthcare Provider Details

I. General information

NPI: 1316525835
Provider Name (Legal Business Name): KELSY DIMEFF DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 ZEMKE AVE
TAMPA FL
33621-5023
US

IV. Provider business mailing address

5581 LAVENDER COTTON PL
APOLLO BEACH FL
33572-3481
US

V. Phone/Fax

Practice location:
  • Phone: 813-828-2273
  • Fax:
Mailing address:
  • Phone: 734-735-4551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0102207500
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: