Organization
DYNAMIC HEALTHCARE PROVIDERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMUEL E KELLY ED.D., PH.D (CLINICIAN)
(954) 202-9334
Entity
Organization
Contact information
Practice address
2901 W OAKLAND PARK BLVD, #A1, OAKLAND PARK, FL 33311-1243
(954) 202-9334
(954) 202-7912
Mailing address
2901 W OAKLAND PARK BLVD, #A1, OAKLAND PARK, FL 33311-1243
(954) 202-9334
(954) 202-7912
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
MH3876
FL
251S00000X
Community/Behavioral Health Agency
Primary
MH3876
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
676033396
—
FL
05
—
676033398
—
FL
Enumeration date
03/17/2010
Last updated
01/05/2017
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