DR. EDWARD F KELLENBERGER (NPI# 1487817904) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487817904 |
| Entity Type | Individual |
| Full Name | DR. EDWARD F KELLENBERGER |
| Credential | M.D. |
| Practice Address |
10050 Sw Innovation Way Ste 102 Port St Lucie FL 34987-2117 |
| Mailing Address |
Po Box 417 Stuart FL 34995-0417 |
| Practice Telephone | 7723443811 |
| Practice Fax Number | 7723352422 |
| Mailing Telephone | 7722232832 |
| Mailing Fax Number | 7724193811 |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2020-10-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
ME120630 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | RAILROAD MEDICARE | P01366910 | 01 |
| FL | 012834800 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1651 Se Tiffany Ave, Port St Lucie, FL 349527564 | 7724193810 | 7724193811 |
| 10050 Sw Innovation Way Ste 102, Port St Lucie, FL 349872117 | 7723443811 | 7723352422 |
| Street Address |
10050 SW INNOVATION WAY STE 102 |
| City | PORT ST LUCIE |
| State | FL |
| Zip Code | 34987-2117 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235596461 | Jacquelyn Freeman | Physician Assistant | 10050 Sw Innovation Way Ste 102, Port St Lucie, FL 34987-2117 | 2016-01-19 |
| 1942572607 | Jeffrey Daniel Bien | Physician Assistant | 10050 Sw Innovation Way Ste 102, Port St Lucie, FL 34987-2117 | 2012-01-27 |
| 1235394891 | Zackary Elias Boomsaad | Pain Medicine | 10050 Sw Innovation Way Ste 102, Port St Lucie, FL 34987-2117 | 2008-07-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093299604 | Karen Cecilia Wong Li James | Registered Nurse | 10024 Sw Glenbrook Drive, Port Saint Lucie, FL 34987 | 2018-09-19 |
| 1134646151 | B & T Diagnostics LLC | Clinical Medical Laboratory | 11350 Sw Village Pkwy Ste 323, Port Saint Lucie, FL 34987 | 2017-08-30 |
| 1538684048 | Transport With Care, LLC | Non-emergency Medical Transport (VAN) | 1850 Sw Our Ct, Port Saint Lucie, FL 34987 | 2017-08-04 |
| 1154859825 | True Path Diagnostics, LLC | Clinical Medical Laboratory | 11350 Sw Village Pkwy Ste 309, Port St Lucie, FL 34987 | 2017-05-25 |
| 1316326515 | Aleksey Alekseyenko | Family Medicine | Mhpg Primary Care @ Tradition Health Park II, 10080 Sw Innovation Way Suite 201, Port St Lucie, FL 34987 | 2015-05-21 |
| 1053658583 | Tameka Argo | Contractor | 7664 Germany Canal Road, Fort Pierce, FL 34987 | 2013-01-03 |
| 1780967976 | Mennette J Colon | Specialist/Technologist, Other | 1970 Sw Glendale St., Port Saint Lucie, FL 34987 | 2011-09-23 |
| 1366416257 | Cynthia A Dolan | Dermatology | 10080 Sw Innovation Way Ste 301, Port St Lucie, FL 34987 | 2006-02-15 |
| 1205829074 | Andres M Reyes | Internal Medicine | 10050 Nw Innovation Way, Suite 102, Port St Lucie, FL 34987 | 2005-08-26 |
| 1720498470 | Josue Limage | Family Medicine | 10080 Sw Innovation Way Ste 201, Port St Lucie, FL 34987 | 2014-05-03 |
| Find all providers in zip 34987 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093820417 | Tagrid Adili | Psychiatry & Neurology | 463 Nw Prima Vista Blvd, Port St Lucie, FL 34983 | 2006-08-19 |
| 1508833039 | Jose Antonio Arbona | Psychiatry & Neurology | 1889 Se Port St Lucie Blvd, Port St Lucie, FL 34952-5530 | 2006-03-03 |
| 1508868779 | Jose Jorge Pozo | Psychiatry & Neurology | 240 Nw Peacock Blvd, Suite 101, Port St Lucie, FL 34986-2274 | 2005-06-01 |
| 1639425986 | Kathie Kowalczyk | Psychiatry & Neurology | 10080 Sw Innovation Way Ste 201, Port St Lucie, FL 34987-2129 | 2012-07-24 |
| 1508005273 | St. Cloud Neurology, P.a. | Psychiatry & Neurology | 451 Sw Bethany Dr, Suite 101, Port St Lucie, FL 34986-1964 | 2009-02-19 |
| 1346439114 | Dr Jose J Pozo Pa | Psychiatry & Neurology | 240 Nw Peacock Blvd, Suite 101, Port St Lucie, FL 34986-2274 | 2007-10-17 |
| 1639209273 | Sophia Ahmed | Psychiatry & Neurology | 1700 Se Hillmoor Dr, Port St Lucie, FL 34952-7539 | 2007-03-06 |
| 1376562918 | Tracey E Cerbone | Psychiatry & Neurology | 1651 Se Tiffany Ave, Ste 102, Port St Lucie, FL 34952-7564 | 2006-07-18 |
| 1568418325 | Luz G Vazquez | Psychiatry & Neurology | 1701 Se Hillmoor Dr, Ste D16, Port St Lucie, FL 34952-7541 | 2006-05-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043820087 | Lewis Leckey Hamilton | Psychiatry & Neurology | 471 Palm Ave, Boca Grande, FL 33921-1157 | 2020-08-04 |
| 1588282776 | Magic Medical Specialties Corp | Psychiatry & Neurology | 9421 S Orange Blossom Trl # 19, Orlando, FL 32837-8320 | 2020-07-14 |
| 1235757899 | Miami Headache Center, Pllc | Psychiatry & Neurology | 5415 Collins Ave Apt Phe, Miami Beach, FL 33140-2575 | 2020-07-10 |
| 1982220307 | Thornley Health, LLC | Psychiatry & Neurology | 4014 Sawyer Rd, Sarasota, FL 34233 | 2020-06-22 |
| 1104458462 | Neuro Synchrony LLC | Psychiatry & Neurology | 1745 E Hwy 50 Ste B1, Clermont, FL 34711-5190 | 2020-02-05 |
| 1568008373 | Tallahassee Memorial Healthcare Inc | Psychiatry & Neurology | 7514 Park Springs Cir, Orlando, FL 32835-2619 | 2019-11-27 |
| 1104387935 | Remyelix Neurology & Multiple Sclerosis Institute, Pllc | Psychiatry & Neurology | 4907 N Florida Ave, Tampa, FL 33603-2119 | 2019-03-26 |
| 1811461353 | Ricardo Villalobos Pa | Psychiatry & Neurology | 16606 Broadwater Ave, Winter Garden, FL 34787 | 2019-01-17 |
| 1164995528 | Rayyan Neurological Association LLC | Psychiatry & Neurology | 10022 Crystalline Ct, Orlando, FL 32836-6024 | 2019-01-09 |
| 1326511007 | Parkinsons & Memory Center Pa | Psychiatry & Neurology | 919 N Osprey Ave # B, Sarasota, FL 34236-4143 | 2019-01-06 |
| Find all providers with the same taxonomy | ||||
| City | PORT ST LUCIE |
| Zip Code | 34987 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.