Individual
KELLY GASSIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1251 HICKORY ST, MELBOURNE, FL 32901-3221
(321) 434-3420
(321) 434-3423
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 434-3420
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
ME129537
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
118717900
—
FL
01
—
Q6861
MEDICARE HF
FL
01
—
Q6862
MEDICARE HFPSI
FL
Enumeration date
04/23/2015
Last updated
09/12/2023
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