Provider Demographics
NPI:1457311979
Name:KELLY, SHERYLL ANN
Entity Type:Individual
Prefix:MRS
First Name:SHERYLL
Middle Name:ANN
Last Name:KELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 WILTON AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-4450
Mailing Address - Country:US
Mailing Address - Phone:407-422-0193
Mailing Address - Fax:407-422-0193
Practice Address - Street 1:1437 WILTON AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-4450
Practice Address - Country:US
Practice Address - Phone:407-422-0193
Practice Address - Fax:407-422-0193
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver