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NPI Code Detail

MEDICARE: KELLY M DUNNE PA-C

MEDICARE: KELLY M DUNNE PA-C
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
1363A00000XPhysician Assistant1223SC
2363AM0700XMedical Physician AssistantPA9103581FL
3363AM0700XMedical Physician Assistant3352AZ
4363A00000XPhysician AssistantPA9103581FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3PA9103581OTHERFLMEDICAL LICENSE

General Provider Information

NPI Number : 1598741316
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY M DUNNE PA-C
Provider Business Mailing Address
First Line : 2415 N ORANGE AVE STE 601
Second Line :
City : ORLANDO
State : FL
Zip : 32804-5558
Country : US
Telephone Number : 407-303-2070
Fax Number :
Provider Business Practice Location Address
First Line : 2415 N ORANGE AVE STE 601
Second Line :
City : ORLANDO
State : FL
Zip : 32804-5558
Country : US
Telephone Number : 407-303-2070
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2005
Last Update Date : 01/12/2023

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Directions to “ KELLY M DUNNE PA-C” Practice Location

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