Provider Demographics
NPI:1245296318
Name:KENNEDY, PAMELA SCHOFIELD (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:SCHOFIELD
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 THOMASWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-7915
Mailing Address - Country:US
Mailing Address - Phone:850-656-4555
Mailing Address - Fax:850-656-4557
Practice Address - Street 1:1355 THOMASWOOD DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-7915
Practice Address - Country:US
Practice Address - Phone:850-656-4555
Practice Address - Fax:850-656-4557
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 84319207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H63110Medicare UPIN
15007YMedicare ID - Type Unspecified