Provider Demographics
NPI:1346534674
Name:FOSTER, KELLY DANIELLE (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:DANIELLE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:DANIELLE
Other - Last Name:DORSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 160748
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32716-0748
Mailing Address - Country:US
Mailing Address - Phone:561-253-3980
Mailing Address - Fax:
Practice Address - Street 1:1630 S CONGRESS AVE STE 200
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-2171
Practice Address - Country:US
Practice Address - Phone:561-253-3980
Practice Address - Fax:561-253-3985
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036134544207R00000X, 207RH0002X, 207RX0202X
FLME152134207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine