Shannon Kathleen Kelly, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9112296 Issued in FL

Practice address

5800 Central Gardens Way Apt 204
Palm Beach Gardens, FL 33418-4125

Phone

(561) 427-8799

NPI assigned

Jul 6, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1562371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664841600000",
    "number": "1831751262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5800 CENTRAL GARDENS WAY APT 204",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334184125",
            "telephone_number": "561-427-8999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5800 CENTRAL GARDENS WAY APT 204",
            "city": "PALM BEACH GARDENS",
            "state": "FL",
            "postal_code": "334184125",
            "telephone_number": "561-427-8799"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6103 Winding Lake Dr",
            "address_purpose": "LOCATION",
            "city": "Jupiter",
            "state": "FL",
            "postal_code": "334583762",
            "country_code": "US",
            "telephone_number": "561-427-8799",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "SHANNON",
        "middle_name": "KATHLEEN",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-06",
        "last_updated": "2022-10-04",
        "certification_date": "2022-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9112296",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCPA ID",
            "identifier": "1148870",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jill Kelderman, PH.D.
• Sylvia L Keller, PH. D., LMHC, CAP
• Taylor Marie Keller
• Devan R Kelley
• Catherine Amanda Kelly, NP
• Douglas Kennedy, PHARM.D.
• Stefanie Kenney
• Craig H Kerns, M.S.
• Brittany Nicole Kerr
• Steven C Kessel, M.D.

• Physician Assistant in Palm Beach Gardens, FL
• Providers in Palm Beach Gardens, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.