MEDICARE: AMANDA A KELVEY D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS22822	FL
2	207Q00000X	Family Medicine Physician	278717	MA

General Provider Information

NPI Number	:	1083064026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA A KELVEY D.O.

Provider Business Mailing Address
First Line	:	201 LAGRANDE BLVD
Second Line	:
City	:	LADY LAKE
State	:	FL
Zip	:	32159-1303
Country	:	US
Telephone Number	:	352-753-0606
Fax Number	:	352-753-0650

Provider Business Practice Location Address
First Line	:	201 LAGRANDE BLVD
Second Line	:
City	:	LADY LAKE
State	:	FL
Zip	:	32159-1303
Country	:	US
Telephone Number	:	352-753-0606
Fax Number	:	352-753-0650

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2016
Last Update Date	:	12/12/2025

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Directions to “ AMANDA A KELVEY D.O.” Practice Location

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