Provider Demographics
NPI:1083064026
Name:KELVEY, AMANDA A (DO)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:A
Last Name:KELVEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 LAGRANDE BLVD
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-1303
Mailing Address - Country:US
Mailing Address - Phone:352-753-0606
Mailing Address - Fax:352-753-0650
Practice Address - Street 1:201 LAGRANDE BLVD
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-1303
Practice Address - Country:US
Practice Address - Phone:352-753-0606
Practice Address - Fax:352-753-0650
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2025-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS22822207Q00000X
MA278717207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIRES000Medicare UPIN