MEDICARE: SHELBY BLISS

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
1	106H00000X	Marriage & Family Therapist	IMT2583	FL

General Provider Information

NPI Number	:	1487197570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY BLISS

Provider Business Mailing Address
First Line	:	270 N SYKES CREEK PKWY STE 106
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-3494
Country	:	US
Telephone Number	:	321-323-9069
Fax Number	:

Provider Business Practice Location Address
First Line	:	270 N SYKES CREEK PKWY
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-3492
Country	:	US
Telephone Number	:	321-323-9069
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2016
Last Update Date	:	11/08/2020

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Directions to “ SHELBY BLISS ” Practice Location

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