Provider Demographics
NPI:1245318351
Name:KENNEDY, SCOTT HERBERT (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:HERBERT
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 ULMERTON RD # 252
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-3337
Mailing Address - Country:US
Mailing Address - Phone:727-460-9991
Mailing Address - Fax:
Practice Address - Street 1:2655 ULMERTON RD # 252
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-3337
Practice Address - Country:US
Practice Address - Phone:727-460-9991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46468207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA01772Medicare UPIN