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General NPI Number Information
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NPI Number | 1568843852
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Entity Type | Individual
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Provider Name | KELLY ELIZABETH BREESE AU.D.
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Gender | Female
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Dates
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Enumeration Date | 06/12/2015
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Last Update Date | 02/06/2023
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Provider Practice Location Address
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Address Line | 2085 SIESTA DR STE 3
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City | SARASOTA
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State | FL
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Zip | 34239-5201
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Country | US
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Telephone | 941-366-2240
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Fax | 941-312-5602
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Provider Business Mailing Address
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Address Line | 2085 SIESTA DR STE 3
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City | SARASOTA
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State | FL
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Zip | 34239-5201
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Country | US
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Telephone | 941-366-2240
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Fax | 941-312-5602
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AY1950
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License Number State | FL
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