Healthcare Provider Details

I. General information

NPI: 1528277324
Provider Name (Legal Business Name): VICTOIRE ELITE KELLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N LAKEMONT AVE
WINTER PARK FL
32792-3273
US

IV. Provider business mailing address

1540 INTERNATIONAL PKWY STE 2000
LAKE MARY FL
32746-5096
US

V. Phone/Fax

Practice location:
  • Phone: 407-646-7812
  • Fax: 407-303-0475
Mailing address:
  • Phone: 434-882-1461
  • Fax: 434-208-2157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME120643
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101247892
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME120643
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101247892
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: