Individual
KELLY MARIE KISIDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
853 SR 436, SUITE 2099, CASSELBERRY, FL 32707
(407) 906-6167
Mailing address
9775 DORIATH CIR, ORLANDO, FL 32825-8796
(941) 374-3332
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
27040
FL
Other
Enumeration date
01/08/2025
Last updated
01/08/2025
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