Individual
MR. KELLY SIMEON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
360 SE 12TH AVE APT 1, DEERFIELD BEACH, FL 33441-4449
(954) 256-3673
(800) 390-1648
Mailing address
PO BOX 5941, HOLLYWOOD, FL 33083-5941
(954) 256-3673
(800) 390-1648
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
S550500732920
FL
Other
Enumeration date
06/17/2020
Last updated
06/17/2020
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