Provider Demographics
NPI:1538515804
Name:AMODEO, KELLIE ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:ANNE
Last Name:AMODEO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KELLIE
Other - Middle Name:ANNE
Other - Last Name:HELIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9291 MEDICAL PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9126
Mailing Address - Country:US
Mailing Address - Phone:843-764-1730
Mailing Address - Fax:843-764-1731
Practice Address - Street 1:9291 MEDICAL PLAZA DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9126
Practice Address - Country:US
Practice Address - Phone:843-764-1730
Practice Address - Fax:843-764-1731
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC862572086S0102X, 208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program