Healthcare Provider Details

I. General information

NPI: 1700205952
Provider Name (Legal Business Name): SEAN M. KELLY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 09/03/2026
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 WEST DR. MARTIN LUTHER KING JR. BLVD. SUITE 590
TAMPA FL
33607
US

IV. Provider business mailing address

1840 MEASE DRIVE SUITE 309
SAFETY HARBOR FL
34695
US

V. Phone/Fax

Practice location:
  • Phone: 813-534-6269
  • Fax: 813-870-0008
Mailing address:
  • Phone: 813-534-6269
  • Fax: 813-870-0008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberOS16080
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number0102207131
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: