Active NPI
Maylen Kelly
- Dentist
- Davie, FL
National Provider Identifier
1255062998
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 27070
- Practice address
- 15142 SW 17TH St
Davie, FL 33326-2044 - Phone
- (954) 701-2794
- NPI assigned
- Jun 22, 2022
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 27070 | FL | Primary |
Addresses
Primary practice location
15142 SW 17TH St
Davie, FL 33326-2044
Mailing address
15142 SW 17TH St
Davie, FL 33326-2044
Phone (954) 701-2794
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 |
|---|---|---|---|
| 27070 | FL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aesthetic Dental PA | Current | Accepting new patients |
Locations
15436 NW 77th Ct
Miami Lakes, FL 33016
Phone (305) 557-5775
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1655856000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1772668800000",
"number": "1255062998",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15142 SW 17TH ST",
"city": "DAVIE",
"state": "FL",
"postal_code": "333262044",
"telephone_number": "954-701-2794"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15142 SW 17TH ST",
"city": "DAVIE",
"state": "FL",
"postal_code": "333262044",
"telephone_number": "954-701-2794"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "MAYLEN",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-06-22",
"last_updated": "2026-03-05",
"certification_date": "2026-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "27070",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Davie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.