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KYLE SCULLY

License Number: PA9111560

Data As Of 12/22/2024

Profession
Physician Assistant
License
PA9111560
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
09/11/2018
Address of Record
2627 West Eau Gaille Blvd.
Suite 101
MELBOURNE, FL 32935
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No
Address
8725 N. Wickham Rd, Ste. 301
MELBOURNE, FL 32940
Address
205 E Nasa Blvd, 1st Flr
MELBOURNE, FL 32901
Address
1425 Malabar Rd NE
MELBOURNE, FL 32907
Address
1350 S. Hickory Street
MELBOURNE, FL 32901
Address
701 W. Cocoa Beach Causeway
COCOA BEACH, FL 32931
Name Relationship Profession License Effective Date
AGOSTO DIAZ, EDIL J Supervising Prescribing Practitioner Medical Doctor 102761 04/15/2020
ALVAREZ, COREY Supervising Prescribing Practitioner Medical Doctor 131625 04/15/2020
BRONSTEMA, CLARENCE JAMES DO Supervising Prescribing Practitioner Osteopathic Physician 9722 04/15/2020
BROWN, MARTY RAY M D Supervising Prescribing Practitioner Medical Doctor 75648 04/15/2020
CAPUTO, MARK E Supervising Prescribing Practitioner Medical Doctor 94049 12/20/2018
CHAO, MAURICE JAY Supervising Prescribing Practitioner Osteopathic Physician 8629 04/15/2020
CROSS, WILLIAM IAN Supervising Prescribing Practitioner Osteopathic Physician 10316 10/25/2022
CSORTAN, ERIC STEVEN Supervising Prescribing Practitioner Medical Doctor 84708 04/15/2020
DEVAUX, MIKAELA ELISE Supervising Prescribing Practitioner Medical Doctor 130853 04/15/2020
DEVEREAUX, DANIELLE Supervising Prescribing Practitioner Medical Doctor 129224 04/15/2020
DUCKWORTH, ANGELA LEEANN MD Supervising Prescribing Practitioner Medical Doctor 112929 04/15/2020
DUDLEY, LARISSA SOPHIA Supervising Prescribing Practitioner Medical Doctor 131434 04/15/2020
FLEMING, MICHAEL MD Supervising Prescribing Practitioner Medical Doctor 133576 04/15/2020
GAGEN, JAMES SHAWN Supervising Prescribing Practitioner Osteopathic Physician 10263 04/15/2020
GREEN, DOUGLAS WARREN MD Supervising Prescribing Practitioner Medical Doctor 81481 04/15/2020
GRIFFIN, JOHN PATRICK MD Supervising Prescribing Practitioner Medical Doctor 78523 04/15/2020
GUTTA, RAJESH Supervising Prescribing Practitioner Medical Doctor 82886 04/15/2020
HOMERICK, MICHAEL JOHN Supervising Prescribing Practitioner Medical Doctor 119113 04/15/2020
JOCKOVICH, MILAN MD Supervising Prescribing Practitioner Medical Doctor 65559 04/15/2020
JONES JR, PRESTON M Supervising Prescribing Practitioner Medical Doctor 162801 08/17/2023
JONES, PRESTON MICHAEL MD Supervising Prescribing Practitioner Medical Doctor 51045 04/15/2020
LLINAS, JACQUELINE B MD Supervising Prescribing Practitioner Medical Doctor 68727 04/15/2020
MATHEW, DANA RICHARDS MD Supervising Prescribing Practitioner Medical Doctor 128175 04/15/2020
MCGOOHAN, MICHAEL PATRICK DO Supervising Prescribing Practitioner Osteopathic Physician 6325 04/15/2020
MILES, JAMES TIMOTHY Supervising Prescribing Practitioner Medical Doctor 76017 04/15/2020
OLIVEIRA, BRIAN MARIO Supervising Prescribing Practitioner Medical Doctor 110586 04/15/2020
OSWALD, NED ANTHONY MD Supervising Prescribing Practitioner Medical Doctor 121076 04/15/2020
PIRAZZI-MARQUEZ, BEATRIZ M Supervising Prescribing Practitioner Medical Doctor 102083 04/15/2020
RAMAGE, DARRON TRAVIS Supervising Prescribing Practitioner Medical Doctor 115024 04/15/2020
ROTOLO, ALYSSA BIXBY Supervising Prescribing Practitioner Medical Doctor 127035 04/15/2020
ST CLAIR, AARON LEE Supervising Prescribing Practitioner Medical Doctor 106075 04/15/2020
STOJANOVSKI, MIHAIL METODIJA Supervising Prescribing Practitioner Medical Doctor 130869 04/15/2020
TAIVAL, BRANDON JEAN DO Supervising Prescribing Practitioner Osteopathic Physician 9481 04/15/2020
TYMKOWICZ, ALEXANDRIA Supervising Prescribing Practitioner Medical Doctor 156308 03/14/2023
VAN HEMEL, ELIZABETH ANNE Supervising Prescribing Practitioner Physician Assistant 3575 10/25/2022
VAZQUEZ, JOHNNY J Supervising Prescribing Practitioner Medical Doctor 97644 04/15/2020
WALKER, GEORGE HAROLD MD Supervising Prescribing Practitioner Medical Doctor 70189 04/15/2020
WEBER, DOUGLAS ANTHONY Supervising Prescribing Practitioner Medical Doctor 143900 05/01/2020
WEEMAN, MITCHELL Supervising Prescribing Practitioner Medical Doctor 160791 07/26/2023
YOUNG, VICTOR CHANCE Supervising Prescribing Practitioner Osteopathic Physician 8339 04/15/2020

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Name Relationship Profession License Effective Date

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Name Relationship Profession License Effective Date

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No Continuing Education Hours Received from Approved Providers As Of 12/22/2024



* To find out more about Approved Providers, or ask a provider why the course you took is not yet listed, please visit our Continuing Education Providers page.


** Personal Development is limited to no more than 3 hours per renewal cycle. Any personal development hours in excess of this 3 hour maximum cannot be used for renewal and have been subtracted from the total available for renewal.


Please do not fax proof of Continuing Education hours to the Board Office until you have received your renewal notice in the mail.


For instructions on how to request a license certification of your Florida license to be sent to another state from the Florida Department of Health, please visit the License Certifications web page.