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General NPI Number Information
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NPI Number | 1649513276
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Entity Type | Individual
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Provider Name | KERRY EILEEN RELLER M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/02/2013
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Last Update Date | 01/31/2024
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Provider Practice Location Address
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Address Line | 708 DRUID RD E
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City | CLEARWATER
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State | FL
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Zip | 33756-3914
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Country | US
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Telephone | 727-446-1097
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Fax | 833-941-2542
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Provider Business Mailing Address
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Address Line | 708 DRUID RD. E
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City | CLEARWATER
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State | FL
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Zip | 33756
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Country | US
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Telephone | 727-446-1097
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Fax | 727-441-2195
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME127125
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License Number State | FL
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