Provider Demographics
NPI:1528277324
Name:KELLEY, VICTOIRE ELITE (MD)
Entity type:Individual
Prefix:
First Name:VICTOIRE
Middle Name:ELITE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1540 INTERNATIONAL PKWY STE 2000
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5096
Mailing Address - Country:US
Mailing Address - Phone:434-882-1461
Mailing Address - Fax:434-208-2157
Practice Address - Street 1:200 N LAKEMONT AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3273
Practice Address - Country:US
Practice Address - Phone:407-646-7812
Practice Address - Fax:407-303-0475
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2024-07-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME120643208M00000X, 207Q00000X
VA0101247892208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV6054AMedicare PIN