Provider Demographics
NPI:1922210509
Name:DETURO, KELLEY JUNE (MED)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:JUNE
Last Name:DETURO
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13124 S SUNSET TER
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-9675
Mailing Address - Country:US
Mailing Address - Phone:407-654-2686
Mailing Address - Fax:
Practice Address - Street 1:13124 S SUNSET TER
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-9675
Practice Address - Country:US
Practice Address - Phone:407-654-2686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL811868000Medicaid