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NPI Code Detail

MEDICARE: SHELLEY SGRULLONI BA

MEDICARE: SHELLEY SGRULLONI BA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-21-49918FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1S645783897570OTHERFLDRIVER'S LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043557143
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHELLEY SGRULLONI BA
Provider Business Mailing Address
First Line : 473 JORDAN STUART CIR APT 213
Second Line :
City : APOPKA
State : FL
Zip : 32703-2427
Country : US
Telephone Number : 508-265-6543
Fax Number :
Provider Business Practice Location Address
First Line : 5959 LAKE ELLENOR DR
Second Line :
City : ORLANDO
State : FL
Zip : 32809-4633
Country : US
Telephone Number : 407-490-1453
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2013
Last Update Date : 04/03/2025

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