Provider Demographics
NPI:1629891999
Name:KILKENNY, DANIELLE ALICIA (MED, BS)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ALICIA
Last Name:KILKENNY
Suffix:
Gender:F
Credentials:MED, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4589 CAMBERLY ST
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-7961
Mailing Address - Country:US
Mailing Address - Phone:321-594-1764
Mailing Address - Fax:
Practice Address - Street 1:5650 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-7312
Practice Address - Country:US
Practice Address - Phone:321-383-5594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor