Provider Demographics
NPI:1013901263
Name:MATON, KELLY MAUREEN (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:MAUREEN
Last Name:MATON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MAUREEN
Other - Last Name:O'NEILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3200 SW 60TH CT.
Mailing Address - Street 2:SUITE#302
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4071
Mailing Address - Country:US
Mailing Address - Phone:305-622-8330
Mailing Address - Fax:305-669-6496
Practice Address - Street 1:17615 SW 97TH AVE
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-5636
Practice Address - Country:US
Practice Address - Phone:786-624-5955
Practice Address - Fax:786-268-1738
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218931208000000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02097661Medicaid
NYDD5804Medicare ID - Type Unspecified
NYH08211Medicare UPIN