Provider Demographics
NPI:1063546836
Name:KELLEY, JAMES SHERIDAN (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:SHERIDAN
Last Name:KELLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1009 CLOVERLEA RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6812
Mailing Address - Country:US
Mailing Address - Phone:239-398-3292
Mailing Address - Fax:
Practice Address - Street 1:2355 STANFORD CT UNIT 701
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-4813
Practice Address - Country:US
Practice Address - Phone:239-566-7425
Practice Address - Fax:239-593-3430
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0006137207W00000X
FLLL712207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology