Provider Demographics
NPI:1225548449
Name:DAYHOFF, KELLY MICHELLE (PA)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:MICHELLE
Last Name:DAYHOFF
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:MICHELLE
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN, CEN
Mailing Address - Street 1:6524 SAND LAKE SOUND RD UNIT 3102
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7613
Mailing Address - Country:US
Mailing Address - Phone:561-262-8137
Mailing Address - Fax:
Practice Address - Street 1:1968 PEACHTREE RD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1281
Practice Address - Country:US
Practice Address - Phone:404-605-5478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8657363A00000X, 207RC0200X
FLPA9110773363A00000X, 363AM0700X
FLCNA222035376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No376K00000XNursing Service Related ProvidersNurse's Aide