Provider Demographics
NPI:1669499604
Name:NEDD, KESTER J (DO)
Entity type:Individual
Prefix:
First Name:KESTER
Middle Name:J
Last Name:NEDD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:14400 NW 77TH CT STE 306
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1592
Mailing Address - Country:US
Mailing Address - Phone:305-653-5155
Mailing Address - Fax:305-653-5513
Practice Address - Street 1:14400 NW 77TH CT STE 306
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1592
Practice Address - Country:US
Practice Address - Phone:305-653-5155
Practice Address - Fax:305-653-5513
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS47302084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0485977-00Medicaid
FL0485977-00Medicaid
FL80003Medicare ID - Type Unspecified