Active NPI
Kelly Marie Kisida
- Counselor
- Casselberry, FL
National Provider Identifier
1184434607
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 27040
- Practice address
- 853 Sr 436
Suite 2099
Casselberry, FL 32707 - Phone
- (407) 906-6167
- NPI assigned
- Jan 8, 2025
- Last updated
- Jan 8, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 27040 | FL | Primary |
Addresses
Primary practice location
853 Sr 436
Suite 2099
Casselberry, FL 32707
Mailing address
9775 Doriath Cir
Orlando, FL 32825-8796
Phone (941) 374-3332
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27040 | FL | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1736294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1736294400000",
"number": "1184434607",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9775 DORIATH CIR",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328258796",
"telephone_number": "941-374-3332"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "853 SR 436",
"address_2": "SUITE 2099",
"city": "CASSELBERRY",
"state": "FL",
"postal_code": "32707",
"telephone_number": "407-906-6167"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KISIDA",
"first_name": "KELLY",
"middle_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-01-08",
"last_updated": "2025-01-08",
"certification_date": "2025-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "FL",
"license": "27040",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Casselberry, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.