Provider Demographics
NPI:1932336757
Name:ROSSO, KELLY JOYCE (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JOYCE
Last Name:ROSSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:JOYCE
Other - Last Name:KIELBOWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14416 W MEEKER BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-5284
Mailing Address - Country:US
Mailing Address - Phone:623-876-3880
Mailing Address - Fax:623-285-2710
Practice Address - Street 1:14416 W MEEKER BLVD STE 301
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375
Practice Address - Country:US
Practice Address - Phone:623-876-3880
Practice Address - Fax:623-285-2710
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ543102086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology