Individual
DR. KELLY MAUREEN MATON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
17615 SW 97TH AVE, PALMETTO BAY, FL 33157-5636
(786) 624-5955
(786) 268-1738
Mailing address
3200 SW 60TH CT., SUITE#302, MIAMI, FL 33155-4071
(305) 622-8330
(305) 669-6496
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
218931
NY
2084N0400X
Neurology Physician
Primary
218931
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02097661
—
NY
Enumeration date
09/02/2005
Last updated
10/27/2007
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