Provider Demographics
NPI:1760465926
Name:RAFF-ANUNCIATO, KELLY LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:LYNN
Last Name:RAFF-ANUNCIATO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LYNN
Other - Last Name:ANUNCIATO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:2550 W DR MARTIN LUTHER KING JR BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6302
Mailing Address - Country:US
Mailing Address - Phone:813-684-2229
Mailing Address - Fax:813-413-0226
Practice Address - Street 1:2550 W DR MARTIN LUTHER KING JR BLVD STE C
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6302
Practice Address - Country:US
Practice Address - Phone:813-684-2229
Practice Address - Fax:813-413-0226
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02740207V00000X
FLOS7872207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64048481Medicaid
KY0964901Medicare PIN
G74725Medicare UPIN
0964901Medicare ID - Type Unspecified
KY64048481Medicaid