1245652817 NPI number — DR. ANGELA MASTRACCHIO KELLY-SHELBY ARNP/FNP-C

Table of content: DR. ANGELA MASTRACCHIO KELLY-SHELBY ARNP/FNP-C (NPI 1245652817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245652817 NPI number — DR. ANGELA MASTRACCHIO KELLY-SHELBY ARNP/FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KELLY-SHELBY
Provider First Name:
ANGELA
Provider Middle Name:
MASTRACCHIO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
ARNP/FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245652817
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
627 QUINBY WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THE VILLAGES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32162-8698
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-391-4818
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
627 QUINBY WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THE VILLAGES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32162-8698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-391-4818
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/15/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  FL ARNP # 2202962 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 590634434-008 . This is a "HUMANA-MILITARY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 500022154 . This is a "RR MEDICARE GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 3023141-00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7555531 . This is a "PRO-AMERICA-BCE EMERGIS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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