Provider Demographics
NPI:1134198963
Name:KINDELAN, KEVIN M (PHD)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:M
Last Name:KINDELAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1257S PORTOFINO DR A106
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34242-3147
Mailing Address - Country:US
Mailing Address - Phone:863-289-8900
Mailing Address - Fax:941-203-5836
Practice Address - Street 1:391 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3047
Practice Address - Country:US
Practice Address - Phone:863-297-5463
Practice Address - Fax:863-299-1384
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2345103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75812AMedicare ID - Type UnspecifiedPSYCHOLOGIST