MEDICARE: DR. KELLY ANNE SANTANDREA PSY.D

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	103TC0700X	Clinical Psychologist	PY11005	FL

General Provider Information

NPI Number	:	1891385407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY ANNE SANTANDREA PSY.D

Provider Business Mailing Address
First Line	:	1725 MAIN ST STE 223
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33326-3671
Country	:	US
Telephone Number	:	786-210-4266
Fax Number	:

Provider Business Practice Location Address
First Line	:	1725 MAIN ST STE 223
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33326-3671
Country	:	US
Telephone Number	:	786-210-4266
Fax Number	:

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

Provider Enumeration Date	:	01/19/2021
Last Update Date	:	12/20/2022

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