MEDICARE: SABRINA YVETTE KELLEY LPN

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	247ZC0005X	Clinical Laboratory Director (Non-physician)		FL

General Provider Information

NPI Number	:	1922626795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SABRINA YVETTE KELLEY LPN

Provider Business Mailing Address
First Line	:	3901 TITELIST CT APT 2337
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-3296
Country	:	US
Telephone Number	:	407-403-2061
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 W SR 436 STE 2005
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-3053
Country	:	US
Telephone Number	:	407-403-2061
Fax Number	:

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

Provider Enumeration Date	:	07/08/2020
Last Update Date	:	07/08/2020

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