Provider Demographics
NPI:1508326695
Name:DAGES, KELLEY NICOLE (MD)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:NICOLE
Last Name:DAGES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 SW 87TH AVE STE C-340
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3570
Mailing Address - Country:US
Mailing Address - Phone:507-284-2551
Mailing Address - Fax:
Practice Address - Street 1:2021 E COMMERCIAL BLVD STE 305
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3769
Practice Address - Country:US
Practice Address - Phone:954-492-5525
Practice Address - Fax:954-492-1755
Is Sole Proprietor?:No
Enumeration Date:2019-03-23
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME172599207KA0200X
MN67726207K00000X
MN30014207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine