Provider Demographics
NPI:1043738438
Name:ARIAS, KELLY SHARPE (AUD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:SHARPE
Last Name:ARIAS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:SHARPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:215 SHUMAN BLVD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563
Mailing Address - Country:US
Mailing Address - Phone:630-303-5380
Mailing Address - Fax:630-303-5385
Practice Address - Street 1:1722 DEL PRADO BLVD S STE 2
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-5522
Practice Address - Country:US
Practice Address - Phone:239-458-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY2136231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1477979771Medicaid